Please print out this form and send it along with you donation to;

Please make check or money order payable to: Elliot Berlin in trust c/o Berlin & Azoulay

Berlin & Azoulay
16 Esna Park Drive, suite 101
Markham, Ontario,
Canada, L3R 5X1

Name:________________________________________________________

Company Name (If Applicable):________________________________

Address:_____________________________________________________

Telephone:___________________________________________________



Yes!  I would like to donate to the satellite legal fund.

I am enclosing my donation of $_________________________