AT&T Association Rewards Program and Signup Form

We invite you to support Child Foundation by signing up in ICM/AT&T Association Loyalty Program. Through this unique program, you can start contributing to Child Foundation without donating. This program enables Child Foundation to receive up to 5% of your monthly long distance usage from AT&T at no cost to you. If you are already using AT&T as your long distance company, you may still sign up for this program. If you are using another long distance company, then you may choose AT&T, and sign up to have Child Foundation receive a portion of your bill payment.

If you are an existing AT&T customer, simply fill out the form below and e-mail it back to us. Signing up to this program will not effect your current services and benefits with AT&T.

If you are a non-AT&T customer and you switch to AT&T, not only will you get a $25 credit on your second month phone bill, you will also be able to participate in one of AT&T's highly competitive promotions. Also, Child Foundation will receive an additional $6 per customer who switches.

To enroll or if you have any questions, please call ICM at 1-800-426-0015 option 3 and mention Child Foundation (Association Code 9215) or call Child Foundation at (503) 698-4084,

or

Click the Submit button after you have completed all fields of the form below.

Child Foundation will continue to receive contributions as long as you are with AT&T and spend at least $25 per month on your long distance phone bill.

SIGN UP FORM

Date

Billing Phone #

Additional Phone # You may include residential fax lines

Current Long Distance Carrier (Check One) AT&T MCI SPRINT Other

Average Monthly Long Distance Bill: (Check One) $0-$25 $25-$50 $50-100 $100-$200 $200 +

Full Name

Address

City State Zip Code

Native Language

Do you own a business? Yes No

I authorize AT&T to notify my local telephone company of my choice to switch to AT&T for all telephone numbers listed on this form. I understand I may choose (1) long distance company for each telephone number. I also understand the local telephone company may charge a small fee for this and any later change. However, I will receive a $25 credit on my second month phone bill.

Yes, I am an AT&T customer and I want to participate in this ICM/AT&T program.

Signature (Please type your name)