Yes! I want to help keep the S.S. JOHN W. BROWN steaming. Here is my contribution to
Project Liberty Ship.
Check appropriate box: ____ $1000 ____ $500 ____ $100 ____ Other
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| Address: |
_________________________________________________ Apt. ______________ |
| City: |
_______________________________ |
State: ____________ |
| ZIP/Postal Code: |
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Country: ____________ |
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| Telephone: |
Day/Office: (____)_______________ |
Evening/Home: (____)________________ |
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____ Enclosed is my check or money order for the above amount, made payable to
Project Liberty Ship
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____ Please charge my credit card * Information below required for credit card transactions
Credit Card: * (circle one)
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Visa
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Discover
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Master Card
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Credit Card Number: *
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____________/_____________/____________/____________ |
Name on Credit Card: *
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"V" Number (back of card, last
three digits near signature): *
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Expiration Date:*
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| NOT A SECURE SERVER - DO NOT send credit card
information via this website or e-mail |
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Please print and complete this page, and mail or fax to:
PROJECT LIBERTY SHIP
PO Box 25846 Highlandtown Station
Baltimore, MD 21224-0546
Phone: (410) 558-0646 Fax: (410) 558-1737
