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Commitment to Support the Persecuted

I,_______________________________________,agreetocommit:

$5,000.00
$2,500.00
$1,000.00
$500.00
Other:__________
tosupportindividualswhoarebeingpersecutedaroundthecountryforusingand
supportingtheuseofcannabisformedicinalpurposes.

Date:_______________

Signature

Iauthorizetheuseofthefollowingcredit/debitcardformydonation:
Credit/DebitCard#:
ExpirationMonth/Year:

SecurityCode:
NameonCard:
BillingAddress:
BillingCity,State,ZipCode:
EMailandPhone#:

()

AuthorizedSignature:

ORmydonationwillbebycheckorcash:_______madeonorbefore://2016

Iwantmydonationtogospecificallytosupporting(indicatewithyourinitials):

KristofferLewandowskiLegalFund:________
LanceGloorFund:________
SchwabFamily(Kansas)LegalFund:________
Donations will be processed through The Human Solution International (THSI), a federal 501(c)(3) charitable organization. THSI audits, tracks and accounts for all
donations made and 2.5% or less of all donations are used for administrative costs and expenses. Your donation is tax deductible.