Support the 13th Annual Stop Illegal Gun Rally

                                                         X-Offenders for Community Empowerment 

13^th Annual Stop Illegal Gun Rally

September 8, 2012

Please respond by filling out your choice below.

         Yes, I do support this effort and I will attend.  Please accept my donation in the amount of $__________________.

         Yes, I do support this effort but I cannot attend.  Please accept my donation in the amount of $________________.

         Yes, I will attend the workshop.  I will be bringing _________people.

         Yes, I support this effort and wish to donate materials for the event.

 (list items)

            __________________________________________________________

            __________________________________________________________

         Yes, will provide information with a table for the event

Name

Organization

Address                                                Phone                                    E-mail

A $100.00 donation will qualify you as an official sponsor, and your name will be placed on the back of the commemorative T-Shirt.

Please return this form to X-Offenders for Community Empowerment

2227 N. Broad Street

Philadelphia, PA 19122

(267) 325-0335

                         Fax: (215) 992-5423, E-Mail:kimpayton@x-offenders.org

You can also visit our website at www.X-Offenders.org or http://xoffendersofpa.ning.com/ to make a donation