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.
