CLEVELAND PSYCHOANALYTIC CENTER
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Thank you!

You will receive a written acknowledgement of your gift.

 

 

Please enroll me as a  FRIEND OF THE CLEVELAND PSYCHOANALYTIC CENTER

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Your annual tax- deductible contribution to join (check one):

Category Dues  
Patron $500.00  
Donor $250.00  
Sponsor $100.00  
Contributor $ 50.00  
Family $35.00  
Individual $25.00  
 Student $10.00  
  

TO PAY BY CREDIT CARD, FAX YOUR COMPLETED FORM TO (216) 229-7321

If you are not paying by credit card, please make your check payable to: Friends of The Cleveland Psychoanalytic Center and mail your check and this form to:

Cleveland Psychoanalytic Center
2460 Fairmount Boulevard Suite 312
Cleveland, OH 44106-3164