Please print out and return this form to CPRR by mail to CPRR, P. O. Box 21520, Washington D.C. 20009, USA.

Your contact information:

Note: Your contact information will not be passed on to any third party.

Name: _________________________________________________________

Address: _________________________________________________________


_________________________________________________________

City: _________________________________________________________

State/Region: _________________________________________________________

Zip/Postal code: _____________________ Country: __________________________




Registration options:

Please tick boxes [ ] below to select your registration options:

[ ]  I enclose a registration fee

[ ]  This is a family registration for ______ family members. 

Names of family members: ___________________________________________

                         ___________________________________________

                         ___________________________________________

                         ___________________________________________

[ ]  I would like to support CPRR directly by monthly banker's order.
            Please send me more information about this option.

[ ]  I am a Palestinian/Palestinian heir

[ ]  I am a friend of the Palestinians


Please send me regular news about CPRR's work:

[ ]  By mail

[ ]  By e-mail. My address is: ______________________________

[ ]  No need. I have already subscribed to the e-mail news list on your website



Registration fee/additional donation:

I enclose: US$10 x ______ (number of family members)


plus US$______ (optional donation) totalling US$______


Payment method: [ ] check/cheque or money order

[ ] credit card (fill in below)

Credit card info: [ ] VISA
[ ] AMEX
[ ] MASTERCARD


Card number: _ _ _ _   _ _ _ _   _ _ _ _   _ _ _ _


Expiration date: _ _ / _ _


[ ] Please send me a receipt

(this option is for donations only, not registration fees)