The Cozumel Chrysalis Group
PO Box 449, Cozumel, Q Roo, Mexico, 77600

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Please Print Out This Form and Mail With Your Contribution


To sponsor a student, please provide the following information:

Sponsor Name: ________________________________________________

Mailing Address: _____________________________________________

Email Address: ________________________________________________

I would like to sponsor a student of the following grade level:

__  Elementary  (grades 1 - 6)    $100
__  Secondary   (grades 7 - 9)    $220
__  Preparatory (grades 10 - 12)  $220

__  I would like to contribute $ _____ to the General Fund

Checks may be made payable to: 

Cozumel Chrysalis Group

and mailed to: 

Cozumel Chrysalis Group
PO Box 449
Cozumel Q Roo Mexico 77600

Please do NOT send any boxes as we will have to pay import duties that may exceed the value of your donation.

Thank you.

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