Donations to the NYSAC legal fund Donations to the NYSAC Legal Fund Name * First * Last Street Address Address2 City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Email * Phone Number * Fax * If you have any questions on how to use this form please call the NYSAC office at (518) 434-1134. Legal Fund Donation Amount Please type in a numerical value Checkboxes * Platinum Plus* - $3,000.00 Platinum Sponsor - $2,000.00 Gold PLUS * - $1,500.00 Gold Sponsor - $1,000.00 Silver Sponsor - $500.00 OtherOther Legal Fund Donation Amount* Pay by I will be paying by Credit Card/Paypal Online I will be paying by check Please make checks payable to: NYSAC Mail form and payment to: NYSAC 111 Washington Avenue, Suite 501 Albany, NY 12210 Phone (518) 434-1134 Fax (518) 427-0452 info@nysac.com www.nysac.com Total $0.00 If you are human, leave this field blank.
