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NAME __________________________________________________ PHONE_______________
NAME OF ORGANIZATION_________________________________________________________
ADDRESS ______________________________________________________________________
CITY, STATE ZIP CODE____________________________________EMAIL_____________________
METHOD OF PAYMENT
My check is enclosed for $_________________
Please bill to my credit card for the amount $___________ r Visa r MasterCard
Card #_____________________________________ Expiration date__________________
Signature (for credit card)_____________________________________________________
Please make checks payable to
Sonoma State University Academic Foundation, Inc.
Please print this form then mail or fax this form to:
SSU School of Extended Education
Stevenson Hall Rm. 1012
1801 East Cotati Avenue
Rohnert Park, CA 94928-3609
Fax: 707 664 2613
For further information, please call or email Robin Draper at 707.573.1013
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