I wish to join in Cultivating the Vision and maintaining The Oregon Garden.
Please print and complete this form as you wish information to appear on all printed material, including membership cards.

DONOR INFORMATION

Name(s): _______________________________________ Company Name: ___________________________________

Address: __________________________________ City: _____________________ State: _______ Zip: _____________

Home Phone: ________________________ Work Phone: _______________________ Fax: _______________________

Email: __________________________________________________________

Levels of Support
(Please check the category of your choice)
____ Donor Up to $999 annually
____ Bronze $1,000 - $2,499 annually
____ Silver $2,500 - $4,999 annually
____ Gold $5,000 - $9,999 annually
____ Diamond $10,000+ annually

I would like to contribute $ _________every year for the next _______Years.

I prefer to make to _____ Annual _____ Quarterly _____ Monthly payments

I would like to begin payments on ______/_____/______

My total contribution will be $ ______________________

______ Please send me an invoice

OR begin your support today,

______ I have enclosed a check Payable to The Oregon Garden
______ Please charge my credit card
______ Visa _______Master Card ______ Discover ______ AmEx

Cardholder Name: _________________________________________________________
(As it appears on the card.)

Acct#: ________________________________________________ Exp: ________/_______

Signature: ________________________________________________________________

Thank you for your donation. We look forward to seeing you at The Oregon Garden.