Planetary Activation Organization Contribution Form

Name ______________________________________________________

Address ____________________________________________________

____________________________________ Phone _________________

Fax ______________________ E-Mail ____________________________

Date ____________ Enclosed is my contribution of $ __________________

I am paying by: (Please check which item applies)

Cheque _____ Money Order _____

Mastercard _____ Visa _____ Discover _____ Amex _____

Card # ____________________________________ expiry date _______________

Signature: __________________________________________________________

Please send this form with your contribution payable to:

Planetary Activation Organization
P. O. Box 880151
Pukalani, Maui, HI 96788-0151 U.S.A.

Or you can make a direct credit card contribution by Phoning or Faxing the
Planetary Activation Organization at:

Voice mail number: (808) 243-0728 Fax: (808) 573- 2867