The Ukrainian Museum
222 East Sixth Street (bet. 2nd & 3rd Aves.) New York, NY 10003
Wed. thru Sun. 11:30AM-5PM (212) 228-0110
e-mail: info@ukrainianmuseum.org * www.ukrainianmuseum.org
Click here to print this page and mail it to the address above 

DONATION AND PLEDGE FORM
THE UKRAINIAN MUSEUM FUND RAISING INITIATIVE

The Ukrainian Museum is a non-profit 501(c)(3) organization
DATE _______________

[  ] CASH DONATION
     ENCLOSED IS MY CHECK IN THE AMOUNT OF $_______________
     Make check payable to The Ukrainian Museum

[  ] CHARGE YOUR DONATION
     CALL us to make your donation via credit card! 1-212-228-0110
     Mail your credit card information, or FAX to 1-212-228-1947
     
     CHECK ONE:
     [ ]VISA   [ ]MASTERCARD         Donation Amount $_____________

     #_____________________________________   Exp. date: ____________ 

     Name on credit card: ___________________________________________  

     Signature ______________________________________________________

[  ] PLEDGE YOUR DONATION
     I would like to make a PLEDGE in the amount of $______________
     No. of installments - _____ at $____________each.

[  ] My contribution is (check one)
     [ ] in memory of:
     [ ] in honor of (specify birthday, anniversary, _________________):

     _____________________________________________________________________
     (Name in English)

     _____________________________________________________________________
     (Name in Ukrainian)

[  ] My company has a matching gift program. Form is attached.
     Your donation will be doubled up to the amount permitted!

[  ] Please have someone contact me to discuss alternative ways of giving.


Make your selection(s) above and fill in the information below:

____________________________________________________________________________
NAME
____________________________________________________________________________
ADDRESS
____________________________________________________________________________

____________________________________________________________________________
CITY, STATE/PROVINCE, ZIP/Postal Code                            Country

(______)____________________________   _____________________________________
TEL                                    EMAIL

The Ukrainian Museum is grateful for your most generous support!