Print this form, and mail to:
        Baltimore City LEV
        C/O Clint Roby, Treasurer
        1916 E. Pratt St.
        Baltimore, MD 21231

Make your check payable to: "Baltimore City LEV"

Name

Contact

Address

City

State  

Zip Code

Telephone

Fax

E-mail

Contribution

$35    $50    $75     $100      $350
Other  

Volunteer

I'd like to volunteer some time.
I'd like to volunteer a skill.

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