Just print out this form, fill it out, and mail it with your check to:

Solutions at Work
P.O. Box 391349
Cambridge, MA 02139

Yes! I'd like to support Solutions at Work!

Name:__________________________________________________

Address:________________________________________________

City:_________________________State:__________Zip:_________

Phone:______________________________________

Email:_______________________________________

Please charge my _____ VISA or _____ MasterCard

Card No :__________________________________________________

Exp. Date :________________

Signature :_________________________________________________

___ I have enclosed my tax-deductible check payable to Solutions at Work in the amount of:

_____$1,000
_____$500
_____$250
_____$100
_____Other

_____ Please do not include my name in published lists of supporters
         (in the annual report or newsletters).

_____ I'm also interested in volunteering.

Thank you very much.