Join the Rod Serling Foundation by Snail Mail

1.	Print this page.
2.	Clip & complete the form below.
3.	Write out a check to the Rod Serling Memorial Foundation. Minimum $15 membership gets you an email address.
4.	Snail mail the completed form with your donation to:
	The Rod Serling Memorial Foundation PO Box 2101 Binghamton, NY 13902-2101 U.S.A.

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Name Address1 Address 2 City, State ZIP Email	_____________________________ _____________________________ _____________________________ ____________________, ___ ____ ____________@__________._____
Contribution $15 $25 $50 $100	Membership Level Basic email membership Outer Circle Inner Circle Honor Circle
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The Rod Serling Memorial Foundation
is a non-profit organization
registered with the IRS.
All donations are tax deductable.

WE THANK YOU
FOR YOUR CONTRIBUTION!