Donation Form – print and complete

Yes, I am pleased to support the Prairie Aviation Museum with a gift of

          ____$500     ____$250     ____$100      ____$50     Other $_______

Method of Payment

______ Check (payable to Prairie Aviation Museum)

______ Visa  ______ MasterCard

Card #  __ __ __ __ – __ __ __ __ – __ __ __ __ – __ __ __ __  Expiration Date   Mo _________ Yr ___________

Signature ________________________________________________________

Date _______________________________

As You Wish to be Listed

Name ____________________________________________________________________

Address ___________________________________________________________________

City __________________________________________________________ State __________ ZIP _________________

Home Phone _(____ )______________________________­­­­­­­__ Cell _(_____)_____________________________________

Email _____________________________________________________________________________________________

Due to privacy laws, this information will not be used by anyone outside of the Museum.

Prairie Aviation Museum is a not-for-profit charitable organization under 501(c)(3) of the Federal Internal Revenue Code.  Donations to the Museum may qualify as tax-deductible gifts.

After completing this form, please mail it to:

          Prairie Aviation Museum

          % Doug Reeves

          2929 East Empire Street

          Bloomington, IL  61704

Donation form 02/10/14 – 2