Yes, I want to help stop domestic violence by supporting the mission of ACADV.

 

 

 

OR

Enclosed is my tax deductible contribution:

Name: ____________________________________________________________

Address: __________________________________________________________

Phone: ____________________Email: ________________________________

Enclosed is my check for $_________________ OR I pledge $_____________

Payments will be made: _____ Monthly _____ Quarterly _____Annually

Payments to begin on _______________________________________________

_____ I do not want my name to be publicized in connection with this gift.

_____ I would like more information about ACADV.

Please send completed form and/or check to:
Arkansas Coalition Against Domestic Violence
1401 West Capitol, Suite 170
Little Rock, AR 72201

Make checks payable to:
ACADV

We thank you for your generous support of ACADV.

Printer Friendly Version