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Annual Renewal Payment Form <br /> j Please complete and return this form, along with payment and the Annual Activity Report, by mail to the <br /> Council office at 3949 Pender Drive, Suite 120, Fairfax, VA 22030. <br /> Annual Renewal Fee- Due b Jul 31 2008 $115.00 <br /> Y Y ~ <br /> <br /> ' Suggested contribution to the Foundation $75.00 <br /> <br /> : <br /> (Friend of the Foundation up to $1 S0, Contributor $1 SO - $249, Benefactor $2S0 and higher). <br /> Total Amount Enclosed ~ ~ 5 <br /> Council Record Number: <br /> Method of Payment: ? Check # ? MasterCard ? Visa ? American Express <br /> Card Number: Exp. Date: <br /> Name: <br /> Signature: <br /> *Note: Please complete all information above. <br /> DO .NOT FAX ANNUAL ACTIVITY REPORT OR ANNUAL RENEWAL <br /> PAYMENT FORM -ORIGINALS REQUIRED <br /> S CAI N ED°PWA <br /> DATE' <br /> INITIALS' <br /> r~`, \ <br /> ~ <br /> <br />