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Please, fill out this form completely then proceed with printing it.

We cannot accept credit cards at this time.
Make your check or money order payable to:

Niños Latinos Unidos, Inc.
10016 Pioneer Blvd. Suite 123
Santa Fe Springs, CA 90670

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Niños Latinos Unidos, Inc. is a 501(c)(3) organization and thus your gift is tax deductible.

Please list me / us on your honor roll as:

First name
Last name
Street address
Address (cont.)
City, State, Zip
Country
Phone
E-mail

Choose one of the following programs:

			Amount/Cantidad
	The Circle Of Child Protectors El Circulo De Los Protectores De Niños	Any Amount Cualquier Cantidad
	Newborn Benefactors Club Club De Benefactores De Bebes	$100.00 - $249.99
	Infant Benefactors Club Club De Benefactores De Infantes	$250.00 - $499.99
	Adolescent Benefactors Club Club De Benefactores De Adolescentes	$500.00 - $999.99
	The Society Of Guardian Angels Sociedad De Los Angeles Guardiane	$1,000.00+