DONATION FORM

3 Linden Road
Hartland, VT 05048 USA
Tel: 802-436-1277

Fax: 802-436-1281

 

__ Donation to the Donella Meadows Leadership Fellows Program.

__ Donation to the Our Climate Ourselves Program.

__ Donation to the Donella Meadows Archives.

GIFT AMOUNT
[  ] $5000 [  ] $1000 [  ] $500 [  ] $250 [  ] $100 [  ] Other _______     

 

I would like to be a monthly Sustainer. Charge my credit card each month:
[  ] $200/mo [  ] $100/mo [  ] $50/mo [  ] $25/mo [  ] $10/mo [  ] Other _______     
PAYMENT METHOD
[  ] Visa/Master Card no. exp.
[  ] Check (US bank) Make checks payable to "Sustainability Institute"
ADDRESS (Must be same as credit card billing for charges.)
Name:
Address:
 
City:
State Postal Code Country
Signature:
CONTACT
Tel:
Fax:
E-mail:

Please mail or fax this form to:

Sustainability Institute
3 Linden Rd
Hartland, VT 05048

Fax: 1-802-436-1281

THANK YOU!