Organizers' Collaborative Reply Form

Name___________________________________________________

Address________________________________________________

Address________________________________________________

City/St/Zip____________________________________________

Email__________________________________________________

Phone__________________________________________________

Send newsletter via:           ___US Mail     ___email

What is this payment for?     ___Membership   ___ODB Support Fee

Enclosed is:     ___$30 Regular Membership      (see below for support fees)
                 ___$15 Low-income Membership
                 ___$50 Supporting Membership
                 ___$100 Sponsoring Membership
                 ___$200 Sustaining Membership 
                 ___$500 Adopt-An-Intern        (1 10-week intern stipend)
                 ___$1,000 Adopt two interns
                 ___$other

__Check if it is OK to list your name on printed materials as a supporter
  of OC (not on the web site).
__Check if you gave $50 or more and it's OK to list your name and support
  category on the OC web site along with 10 or more other supporters.

For support fee payments, please indicate 
anticipated # of people in your database:   _____________
	
Sliding Scale    ___$30 Level 1 ODB Support Fee    (< $10K)
for ODB support  ___$50 Level 2 ODB Support Fee    ($10K-100K)
is based on      ___$75 Level 3 ODB Support Fee    ($100K-200K)
annual           ___$100 Level 4 ODB Support Fee   ($200K-500K)
income/budget: 	 ___$150 Level 5 ODB Support Fee   (> 500K)

							

	
For Credit Card payment only (MC/Visa/AMEX/Discover):

Name on Card: __________________________________________

Card Number____________________________ Exp Date:_______


(If this is American Express, we will process your payment through
Groundspring; if it is Discover, we will do this through Network
for Good.)

Please return this form to:

OC, Box 400897, Cambridge, MA  02140.  It can be faxed to (617) 695-1295;
no cover page is needed.  Questions?  Call (617) 426-1228 x108.

Organizers' Collaborative is an educational organization incorporated
incorporated in Mass.  We received federal tax-exempt status in July
of 2000, tax ID # 043469389.  Contributions are tax-deductible; ODB
support fees are NOT tax-deductible.

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