ASPR Mail-In / Fax Form

INSTRUCTIONS:   For security purposes you should not enter your credit card information into this form online:

I want to join the ASPR as a: 
I want to make a tax deductible donation in the amount of: (US Funds)
Name
Email
Country
Address
City
State
Zip / Postal Code
Area Code / Telephone
* Credit Card Number
See instructions above.
* Card Expiration Date
See instructions above.
 

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