Thank you so much for your commitment... ...for a world of peace, health and prosperity for all.
This is a "secure" server so your credit card number is protected.
If you are using Netscape, a thin blue line at the top of this window and/or blue unbroken key and/or blue padlock at the bottom indicates that any information you send is protected from unauthorized view by world-class encryption techniques. With Internet Explorer, there will be a graphic of an unbroken key and/or gold padlock at the bottom of your browser window.
(The "tab" key will move you from box-to-box)
To assist us when contacting you, please provide accurate and complete information. (*Required Field)
First Name *
Last Name *
Email *
Organization
Street *
City *
State/Province *
Zip/Post Code *
Country *
Phone *
Credit Card: *
MasterCard
Visa
American Express
Credit Card Number *
CSC * (the 3- or 4-digit Card Security Code printed on your card, as shown)
Start Date
Expiration Date *
Or Call 619-595-0139 with your card number and order information ready.
This is a:
New Membership Renewal
Win Great Prizes for Your Fundraising Accomplishments at These Levels:
Monthly Contribution Category:
Monthly Contributor - Up to $30 monthly Buck-A-Day for Bucky Club - $30 or more monthly Monthly Supporter - $50 or more monthly Century Club - $100 or more monthly Advisory - $500 or more monthly ( ** Ask for details) Millennium Group - $1000 or more monthly ( ** Ask for details) Global Leader - $10,000 or more monthly ( ** Ask for details)
Invoice me monthly for this amount: $ (tax deductible in the USA)
-Or-
One-time Contribution Category:
Contributor - Up to $149 Supporter - $150 to $249 VIP - $250 to $499 ($10 gift certificate for GENI store) Emissary - $500 or more ($20 gift certificate for GENI store) Ambassador - $1,000 or more ($40 gift certificate for GENI store) Diplomat - $10,000 or more ( ** Ask for details) Peacemaker - $100,000 or more ( ** Ask for details)
Invoice me once for this amount: $ (tax deductible in the USA)
Organizations may also apply to become GENI Sponsors. Please fill in the information above and submit it to GENI. We will respond to your pledge application as soon as possible.
(You may want to print this page before you send it, or use the "Save As <file name>" function of your browser, to keep it for your reference files.)
After you press SUBMIT, the computer will pause as it processes the pledge application. Please do not hit the submit button twice as it is normal for the computer to pause while it processes your pledge for a few seconds. It will then show you a confirmation of your pledge in a few moments.
