Support The RZA  

Yes, I am a proud Religious Zionist!

I would like to help secure the future of R.Z.A by enrolling as a:

$1000 PARTNER $750 PARTNER $500 PARTNER $250 PARTNER $100 PARTNER

 DONOR PARTNER *Other: $

* minimum membership contribution $50

 

Member Information:

First Name:    Last Name:   Middle Initial:
Address:
City:             State:       Zip:  
E-mail:   
Phone, Day:  Phone, Evening:    Cell:  Fax:

 

Payment Method:

I/We would like to become a member of RZA for 2007, and pay by check. Please make checks payable to Religious Zionists of America and return along with a printout of this form to:  Religious Zionists of America, 291 Broadway - Second Floor, New York, NY 10007.  

I/We would like to become a member of RZA for 2007, for which I/we agree to charge my credit card  the total amount  of *$ .

Credit Card Payment Information
RZA uses a Secure Server to protect your information.		 Type of Card:

Credit Card # (no spaces):

Exact name as written on card:

Expiration Date*:


I would like to become active in the RZA
I would like to form an RZA chapter
I would like to form a young adult chapter
Please send me information about how to include RZA in my estate plans.

Comments:

  Note:  Please Click 'Submit Form' to submit it securely electronically to the RZA offices

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