Annual Contributor Form
If you wish to use a credit card click, go to our
secure online
donation page.
Please use this form for checks. Please
print this form and mail.
| Friend ($30 - $74) | Benefactor ($500 - $999) |
| Supporter ($75 - $149) | Philanthropist ($1,000 - $2,499) |
| Patron ($150 - $249) | Guarantor ($2,500 - $4,999) |
| Sponsor ($250 - $499) | Land Steward ($5,000 or more) |
Annual OLT Contribution Amount $
___________
o
Check
here if you wish your donation publicly acknowledged.
Joining The Naturist Society (TNS)? $
___________
Click here
for more details about TNS membership.
Total Enclosed
$ ___________
o
Check enclosed made payable to Orient
Land Trust.
Donations and benefits apply to both adults in one household.
Print Name ____________________________________________________________
Second Adult of Household ________________________________________________
Address _______________________________________________________________
City, State & Zip _________________________________________________________
E-mail Address _________________________________________________________
Thank you!! Please mail to:
Orient Land Trust
PO Box 65
Villa Grove, CO 81155-0065
Donations to Orient Land Trust are tax-deductible
under
Section 501(c)(3) of the Internal Revenue Code.
You will be sent a receipt.
See Privacy Notice.
Need help? Call 719-256-4315 9:00 AM - 10:00 PM