To join in supporting the Global Lawyers and Physicians network (non doctors or lawyers are welcome to join), please complete the form. As a supporter, you will be placed on our mailing list and will receive newsletters and updates on current projects and global concerns. We are in the process of developing a network of resources, of which you will be a part. The levels of support are as follows:

Please check one: q  Human Rights and Health Activist                 $50.00 q  Human Rights and Health Supporter              $100.00 q  Human Rights and Health Sponsor                $250.00 q  Human Rights and Health Benefactor           $1000.00 q  Other                                                          $ _______

Please fill in the form and enclose your check or money order, and mail to:

Global Lawyers and Physicians, 715 Albany Street - T357W, Boston, MA 02118

Yes, I would like to support GLP:

Name:       _________________________

Address:    _________________________

City, State: _________________________

Zip:           _________________________

Telephone: _________________________

Fax:          _________________________

Email:       _________________________

Specialy (MD or JD)or occupation: _________________________

Affiliation:  ____________________________________________

Thank you for your support!

If you have any questions, or would like more information, please email [email protected]