YES, I would like to join Earthjustice's William O. Douglas Society! 
 
  *  Contribute by phone. Call (800) 584-6460.
  *  Contribute by mail. Print and complete this form and send to:

			Earthjustice 
			50 California Street, Suite 500 
			San Francisco, CA 94111 

Please select your gift amount: 

	__ $1000  
	__ $1500  
	__ $2000  
	__ $2500  
	__ Other  $____________


Please enter your contact and payment information: 

Email: ______________________________________________

First Name: ____________________  

Last Name: ____________________________________

Address: 
_________________________________________________________________________

City: _______________________________  State: ________  

Postal Code:  ____________

Country:  _______________________

I would like to pay by:  ___ check (please enclose)


               ___ AMEX    ___ VISA    ___ Mastercard    ___ Discover

Card Number:   _______________________________________

Expiration Date:   Month ________  Year _________

Signature:    _________________________________________________

Your contribution is tax-deductible. Should you have any questions, please 
contact us at (800) 584-6460 or by e-mail to info@earthjustice.org.