Donation Form


Name:_____________________________________________________________________
Address:___________________________________________________________________
City / State / Zip:____________________________________________________________
Phone:____________________________________________________________________
E-mail:__________________________________________________________
 
Amount:______________________

 
Method of Payment
[ ] Check enclosed (payable to Cuban Studies Institute)  
[ ] Please place a one-time charge on the credit card listed for the amount of $______________
 
[ ] MasterCard [ ] Visa [ ] American Express [ ] Discover
 
Card Number:__________________________CVV Number___________ Exp. _______
Name as it appears on card: ______________________________________________
Signature: _______________________________________________Date: ____________
 
By Phone: 786-803-8007
By Fax: 786-803-8068

By Mail: Cuban Studies Institute, 1500 S. Dixie Highway, Suite 200, Bank of America Building, Coral Gables, FL 33146