IEC Contact Form

Print this form, fill it out, and mail today to:

	IEC-US
	2912 Diamond St #302
	San Francisco, CA 94131
        call (415)252-5786
        or fax to (415)252-7414


Check all that apply to you:

___ Give me a call, I want to help support the IEC!

    My phone number is _____________________________

___ Add my name to the IEC mailing list.

___ I want to have the IEC Emergency Bulletins mailed to me.
    I have enclosed $1.50 for each future bulletin.

___ I have read the "The Call" (http://www.csrp.org/call.htm)
    and would like to sign on and join the IEC in the battle
    to defend the life of Dr. Abimael Guzman and end the
    isolation. (This statement is the basis of IEC membership.)

___ I want to start a local chapter of the IEC in my area.



                                           (please print clearly)

    Name ________________________________________________________

    Street Address ______________________________________________

    City __________________________ State _______ Zip ___________



Other comments or notes:

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