Adopt-A-Stream Foundation Membership and Northwest Stream Center Campaign

 

Membership Application        New c             Renewal c

 

c Student/Senior  $10      c General/Family  $25    c Contributing  $50        c Sustaining  $100 

c Benefactor  $500          c Corporate   $1000       c Chinook  $5000+

 

 

Northwest Stream Center Campaign:  In addition to my membership, I want to contribute to:

 

c     Streamkeeper Academy Endowment Fund                                  $_________________

 

c     Stream & Wetland Restoration Endowment Fund                      $_________________

 

c     Raised Boardwalk/Interpretive Trail Design/Construction            $_________________

 

c     Trout Stream Exhibit Construction/Operations                           $_________________

 

c     Visitors Building Construction/Maintenance                               $_________________

 

c       Streamkeeper Academy Scholarship for Disadvantaged Youth            $_________________

 

c     Unrestricted Gift in the amount of                                              $_________________

________________________________________________________________________

c       I would like to volunteer with the campaign, call me at                 (____)____________

                    

c       I need more information, send me the NW Stream Center Campaign Brochure

 

Member - Donor Information

_____________________________________________________________

Name (as you would like it to appear in any recognition) Check here c  if you want to remain anonymous.

 

_________________________________________________________________________________

Address

 

_________________________________________________________________________________

City                                                                                                    State                                             Zip

(____)____________________________________________________________________________

Phone                                                                                                E-mail address

 

Payment Method  c Check Enclosed     Please Charge $_______________c Visa    c Mastercard

 

________________________________________________________________________

Card Number                                                                                    Expiration Date

________________________________________________________________________Print Name as it appears on Card

 

c    I want to pledge a gift of $______________to be paid by (date)_________________

 

c  My company will match my gift.  (Please list business name and address below.)

________________________________________________________________________

c   I am interested in donating securities or property and/or establishing a charitable remainder trust.

Please give me a call at: Telephone ______________________

Contact me in the:  AM c PM c Evening c