Mail payments to:
Stop The FTAA
P.O. Box 4632
Rocky Mount, NC 27803

Name: ___________________________________________________________

Company: ________________________________________________________

Address: _________________________________________________________

City: _______________________________ State:_____ Zip:____________

Phone: ______________________________________

Email: ___________________________________________________________

Check box next to desired level of sponsorship:
$10 - Hancock level
$20 - Hamilton level
$50 - Madison level
$75 - Jefferson level
$100 - Franklin level
$250 - Washington level
$_______ - Other

PLEASE DON'T FORGET TO ATTACH CHECK WITH FORM!