Planned Parenthood Southeastern Pennsylvania

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Planned Parenthood Southeastern Pennsylvania Donation Form

Please print this form and mail it with your donation to:

Development Department
Planned Parenthood Southeastern PA
1144 Locust Street
Philadelphia, PA 19107

Yes, I want to help Planned Parenthood Southeastern Pennsylvania protect reproductive freedom, offer quality and affordable healthcare, and provide sexuality education to the youth in our communities.

*Giving Levels*
Margaret Sanger Circle	$50,000 & above
President’s Partner	$25,000 to 49,999
Freedom Keeper	$10,000 to 24,999
Champion for Choice	$5,000 to 9,999
Roe Patron	$2,500 to 4,999
Roe Fellow	$1,000 to 2,499
Sustainer	$500 to 999
Sponsor	$250 to 499
Friend	$100 to 249

I would like to make a payment toward my previous commitment to:

Owning Our Future

Our New Far Northeast Health Center

Pledge-a-Picket

Other

Enclosed is my gift of $__________________

Check made payable to Planned Parenthood Southeastern Pennsylvania or PPSP

Visa Credit Card #: _______________________________ Exp. Date: __________

Mastercard Credit Card #: _________________________ Exp. Date: __________

Please notify the following that this gift has been made:

Name: ______________________________________________________
Company: ___________________________________________________
Address: ____________________________________________________
City, State, Zip: _______________________________________________
Home Phone: __________________ Work Phone: __________________

Please check here if you wish to remain anonymous.

THANK YOU FOR YOUR SUPPORT.

The official registration and financial information of Planned Parenthood may be obtained from the Pennsylvania Department of Sate by calling toll free, within PA, (800) 732-0999. Registration does not imply endorsement.

Administrative Headquarters
1144 Locust Street
Philadelphia, PA 19107
(215) 351-5500
Fax: 215-351-5595

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