| Name | ____________________________________________________ |
| Street address | ____________________________________________________ |
| City, State, Zipcode | ____________________________________________________ |
| Phone | ____________________________________________________ |
| ____________________________________________________ | |
| Amt. of gift | ___$3 ___$8 ___$35 ___$60 ___$100 |
| ___$250 ___$500 ______Other | |
| Pick one | (if your donation is $75 or greater, you may select one of the items below) |
| ______ | The Anti-Racist Cookbook |
| ______ | Lifting the White Veil |
| ______ | Racial Awareness Quiz |
| ______ | Walk with Us |
| (if your donation is $100 or greater, you may select the item below) | |
| ______ | Talking About Race |
| Please make payable to : CSWAC Mail to: CSWAC, 245 West 4th Avenue, Roselle, NJ 07203-1135 |
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