Please print, complete, and mail this form to donate to Culture Wars and Fidelity Press.

Culture Wars
206 Marquette Avenue
South Bend, IN 46617-1111
Tel: (574) 289-9786
Fax: (574) 289-1461

YES, Dr. Jones, I would like to make a tax-deductible donation to further the work of Culture Wars and Fidelity Press.

I enclose ____ $1000, ____ $500, ____ $250, ____ $100, ____ $50, ____ $25, ____ (Specify)


____ I enclose a check or money order in the amount of my donation.

or

____ I prefer to use my credit card:

____ VISA ____ MASTERCARD

CARD #: ________________________ EXPIRATION: ______

SIGNATURE if using Credit Card: _________________________________

NAME: _____________________________________________________

STREET ADDRESS: __________________________________________

CITY: _______________________________________________________

STATE/PROVINCE: ___________________________________________

COUNTRY: __________________________________________________

ZIP/POSTAL CODE: __________________________________________

PHONE: ____________________________________________________