Education Foundation Donation Form Your donation to the PSIAC Education Foundation 501(c)(3) charitable organization is 100% tax deductible.If you would like to submit a donation by check, please disregard this form and mail your check to PSIA-C EF.Address: PSIA/AASI-C, PO Box 2144, Frankfort, MI 49635Name* First Last Billing Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mailing Address (if different than billing) Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* PSIA-AASI National Member ID # (if any)If Tribute Donation please specifify type.In Memory of ...In Honor of ...Please choose the best tribute category.In Tribute Name (if any) If you are making a Tribute Donation please enter the name of the "in tribute" person.Additional Information and/or CommentsPlease share any additional information you'd like to share with us about your contribution.Do you want to remain anonymous?*Yes, I want to remain anonymousNo, I don't mind sharing that I am a donorTypically we share Education Foundation donor names (not specific donation amounts) in the Central Line Newsletter. If you'd like to remain anonymous and have us NOT publish you name as a supporter please choose "Yes" above.PSIAC Education Foundation Donation Amount* If you are donating more than $1,000 we would prefer receiving a check to avoid credit card fees - this maximizes your donation to the Education Foundation - thank you!Total $0.00 Credit CardAmerican ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name CommentsThis field is for validation purposes and should be left unchanged.