PLEASE PRINT THIS FORM AND MAIL IT WITH YOUR DONATION
Drive and Stay Alive, Inc.
2809 Wehrle Dr., Suite 9
Firstly, please delete whichever of the first two paragraphs you do NOT want your money to be used for:
1. I am (or we are) aware that over ten thousand young people between 15 and 24 are being killed each year on the roads of the USA and I/we believe that reducing this dreadful death toll is a vital task. I/we wish to help achieve this by means of a donation to Drive And Stay Alive, Inc., specifically to assist with its growing program of education and information, geared to achieve this precise aim.
2. I am (or we are) aware that over 1.2 million people are being killed each year in road crashes around the world and I/we believe that reducing this dreadful death toll is a vital task. I/we wish to help achieve this by means of a donation to Drive And Stay Alive, Inc., specifically to assist with its unique program of collating and re-publishing data and road safety news from over 100 countries so that safety professionals around the globe can learn from each other and thereby reduce the money and lives that are being squandered while people keep trying to "re-invent the wheel" instead of simply adapting techniques that have already been proven to work elsewhere.
I/we wish to make a donation at one of the following rates, as checked/ticked, below:
(Please send donations as a check/cheque or money order/international money order -- U.S. dollars only)
Platinum Supporter (donation of $50,000 or more) _____
Gold Supporter (donation of $25,000 or more) _____
Silver Supporter (donation of $10,000 or more) _____
Bronze Supporter (donation of $ 5,000 or more) _____
Solid Supporter (donation of $ 1,000 or more) _____
Team Supporter (donation of $ 100 or more) _____
Gift Giver 1 (donation of $ 25 or more) _____
Gift Giver 2 (donation of $ 5 or more) _____
For any of the "Supporter" levels, please indicate here whether you wish to be named on appropriate Drive And Stay Alive, Inc., literature: Yes / No* (delete as appropriate)
IMPORTANT: Drive And Stay Alive, Inc., is a tax-exempt organization under section 501(c)(3) of the Internal Revenue Code. We will send you a receipt in all cases, unless you tell us not to do so.
Please supply the following details, unless you wish to make an anonymous donation:
Name -- individual(s), organization or business: ____________________________________________
Telephone: __________________________ (work) ____________________________ (home)
Is this donation in memory of any specific person/people: Yes / No*
Name(s): _________________________________ (if you wish, tell us why on a separate page)
Would you like to receive occasional Drive And Stay Alive highway safety newsletters:_________
Finally, and most importantly, thank you. All donations will be used towards the task of reducing the carnage on the roads. Your money will be put to vital use.
Executive Director and Editor
Drive and Stay Alive, Inc.