P.O. Box 816, RHINEBECK, NY 12572
Name _______________________________ Address __________________________
Phone _______________________________ City, State, Zip __________________________
Email _______________________________
Enclosed
is my tax deductible check in the amount of $_____________________
Please
enclose your employer’s form if they have a matching grants program, i.e. IBM.
Please apply my payment for the year
200__ as follows:
Individual $10 _____ Sponsor $100 $ _____
Family $15 _____ Lifetime $1,000 $_____
Student $5 _____ Lifetime option $250 x 4 years $
_____
Business $50 _____ Other $_____
Patron $50 _____ Added
Donation $_____
Total $_____
_____ Please notify me in
advance via email of your upcoming events.
_____ Please contact me
about becoming a volunteer.
_____ I have items to donate to the museum for its
permanent collection.