AIA Seattle Emergency Fund/Katrina
Mississippi Mission: Damage Assessment

The AIA Seattle Disaster Preparedness & Response Committee has mounted a damage assessment team, for initial deployment to Mississippi on 9/9/05. The Mission welcomes your interest and support!

NOTE:
IF YOU REQUIRE A RECEIPT, PLEASE PRINT THIS PAGE FOR YOUR RECORDS, PRIOR TO SUBMITTING.

Firm name (if applicable):

Individual name/Contact:

Address:

Phone:

Fax:

Total payment:

VISA/MasterCard #

Expires:

Name on card :

 I am sending a check or money order.
Check this box if you prefer to send a check or money order (payable to AIA Seattle Emergency Fund/Katrina) for the appropriate amount.
Please send to:
AIA Seattle
1911 First Avenue
Seattle, Washington 98101