_________________________
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 # __ __ __ __ – __ __ __ __ – __ __ __ __ – __ __ __ __ CVV __ __ __
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 02/20/20