Cosmic Ray Division Donation Form
I am pleased to support the world class research being conducted in Armenia by the

Cosmic Ray Division of the Yerevan Physics Institute.

Enclosed please find my tax-deductible contribution of :

$100 $200 $500 $1000 $5000 Other $_____ Securities

Yes My company ___________________________ will match my donation.

company name

Name (please print):____________________________________________________

Address: ____________________________________________________

City, State, Zip: ____________________________________________________

Phone: ___________________ e-mail: ___________________________

Please make checks payable to:

Armenian Engineers and Scientists of America.

Be sure to indicate on the memo line of the check “For CRD in Armenia” .

You will receive a receipt directly from AESA and a thank-you letter with pictures of the CRD

research stations and the personnel.

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.

Please remember to ask if your company will make a matching donation. If we need to fill out

forms for this purpose, please include them in this envelop.

Please return this form with your check to

AESA-CRD

C/O Anahid Yeremian

824 S.W. Shoremont Ave.

Seattle, WA 98166

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