Name:_____________________________________________________________

Street/PO Box:______________________________________________________

City:____________________ State: _____ Zip: __________________________

Phone:____________________________________ 

Email:____________________________________

Employer (for matching grant purposes only):_______________________________

Please check the area to which you would like to contribute:

      [  ] Use Wherever Most Needed

      [  ] Margaret C. Nygard Land Acquisition Fund

      [  ] Allen Lloyd Fund for the Upper Eno

      [  ] Stewardship Fund

      [  ] Festival for the Eno

Gift amount:
      [  ] $1000
      [  ] $500
      [  ] $100
      [  ] $50
      [  ] $25
      [  ] Other________

Type of payment:
      [  ] Check    [  ] Mastercard    [  ] Visa

Card number:________________________ Expiration Date:________

Signature:________________________________________________