Name: First:	Last:
Company or  Organization:	Title:
Address:   Street:
City:	State:    Zip:
Email Address:
I would like to contribute to EAC's Annual Appeal by investing   $
Please select from the following choices:
	EAC General Program Support
	OR
	Creating Opportunities for Seniors MORE INFO Empowering People through Employment & Education MORE INFO Supporting People in Recovery MORE INFO Protecting Children MORE INFO Building Strong Families & Communities MORE INFO
Comments or  Instructions:
To Pay by Credit Card:	VISA Mastercard AMEX Discover   Name on Card:     Credit Card #     Exp. Date
To Pay by Check:	Submit this form to notify us of your gift. Then   make your check payable to EAC and mail to: Education & Assistance Corporation 50 Clinton Street, Suite 107 Hempstead, NY 11550 Attn: Development Department

For Additional Information contact:
EAC's Development Department at (516) 539-0150