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AESA/Cosmic Ray Division Donation Form
(please print and fill out this page by clicking your right mouse button on this page and then selecting print from the menu.)

I am pleased to support the world class research being conducted in Armenia by the Cosmic Ray Division of the Yerevan Physics Institute and to help the CRD become financially self sufficient. Enclosed please find my tax deductible contribution of :
$100___	$200___	$500___	$1000___	$5000___	Other $_______

Patron $1000/year for three years___

Friend $500/year for three years___

Securities___

Name (please print):		_______________________________________________
Address:		_______________________________________________
City, State, Zip:		_______________________________________________
Day Phone:		___________________
Evening Phone:		___________________
E-Mail Address:		_________________________________________

Please make checks payable to Armenian Engineers and Scientists of America (AESA)
and indicate on the memo line of the check "For CRD in Armenia".

Please return this form with your check to:
AESA, 417 West Arden Ave., #112C, Glendale, CA 91203

All donors will receive a receipt directly from AESA and a thank-you letter from CRD with pictures of the stations and the staff.

If you wish to make a gift of securities please check the proper box on the form and we will contact you to make the arrangements.

Ask your company for matching contributions. AESA is on the list with many large companies for United Way contribution matching program.

Thank you for your commitment to Armenia's scientific future.