Philadelphia Physicians for Social Responsibility

If you are interested in joining Philadelphia PSR please print and send us this completed page with your tax-deductable gift.


___ $25 Student  Name _________________________________ Title ______
___ $50 Community or Retired Affiliation ____________________________________________
___ $65 Attending/Fellow  Address ____________________________________________
___ $125 Professional City ______________ State __ Zip ____
___ $500 Group or Organization Phone ______________ E-mail _________________
___ $1500 Lifetime Partners 
Please make check payable to: Philadelphia PSR      
  Enclosed is $_________    
*All donors who give at the $1000 or more level will join Friends of PSR, PSR’s Giving Society


Credit Card # (Visa or MasterCard only)

________________________________

 Expiration Date:________
Signature________________________ Zip ___________
 
Thank you for your tax-deductable gift.Your support of Philadelphia PSR is deeply appreciated.
Philadelphia PSR is a non-profit 501(c)(3) organization. Contributions are tax deductable to the extent allowed by law.
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If you have any questions, please contact us
Philadelphia Physicians for Social Responsibility
704 N. 23rd Street Philadelphia, PA 19130 Tel. 215.765.8703 Fax: 215.765.5852 E-Mail:membership@psrphila.org