Print and complete this form and return it along with your check or money order to:
The Center for Sexual Assault Survivors
Attention: Shawna Gray
11030 Warwick Blvd.
Newport News, VA 23601
Name:_________________________________________________________
Mailing Address:_________________________________________________
City:____________________________ State:_________ Zip:____________
E-mail Address:__________________________________________________
Your order will arrive in 3-5 days.
If you have any questions, please call (757) 599-9844
The Center for Sexual Assault Survivors is a public charity under 501(c)(3) of the Internal Revenue Code.
Contributions are deductible to the extent permitted by law. We do not sell or trade our mailing lists.
