CIRA

Application Form For Contributions To CIRA

To make a contribution to CIRA, print this form, and mail it with your check to the address below.


Date ____________________________

Name ___________________________

Affiliation ________________________

Address _________________________

_________________________________

_________________________________

_________________________________

[ ] Check box if new address

Office phone ______________________

Home phone ______________________

Fax _____________________________

E-mail ___________________________
 

 I wish to contribute $.......... to
CIRA to maintain and expand its 
scholarly activities.

Please make check payable to CIRA and send it with your application to Treasurer of CIRA:

Valentine Moghadam
Director, Women Studies Program
Illinois State University
Campus Box 4260
Normal, IL 61790-4260
Please pay your contributions in U.S. dollars on checks drawn on a U.S. bank.
[_private/footer.htm]