Street City State Zip

Father’s Day Campaign Against Domestic Sign your name to be included in the Father’s Day Campaign completely within this box: We may use names and signatures, or just names, depending upon the number of participants.

Please print your name as you would like it appear in the ad. If you are a Religious Leader, Doctor or Judge, please also include your appropriate title.

Name ______

Address ______Street City State Zip Work phone ______Home Phone______

Email ______************************************* We also invite you to make a tax-deductible donation to the Protection From Abuse programs of the YWCA. You may also make a gift to the YWCA online. Please consider one of the following donation levels:

□ $1,000 – Hero □ $500 – Champion □ $100 – Defender □ $50 – Advocate □ $25 – Ally □ $10 – Good Guy □ Other______

I would like my contribution to support □ YWCA Battered Women Shelters □ YWCA AMEND Program for male abusers

Enclosed is my □ Check payable to the YWCA of Greater Cincinnati □ My credit card number to be charged:

Card Type______Expiration ______

Card Number______

Signature______

Print, scan and email to [email protected] Fax to YWCA at (513) 361-2153 or Mail by June 8th to: Father’s Day Campaign YWCA of Greater Cincinnati 898 Walnut Street Cincinnati, OH 45202