Donations to the NYSAC legal fund Donations to the NYSAC Legal Fund Name * First * Last Street Address Address2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming 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.
