DONATION AND PLEDGE FORM
THE UKRAINIAN MUSEUM FUND RAISING INITIATIVE
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 in the name of (or, is to be used toward):
_____________________________________________________________________
(Name the endowment fund or the targeted item that you wish to finance.)
[ ] 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.
[ ] I would also like to BECOME A MEMBER of The Ukrainian Museum.
Check a membership status:
[ ] $40 Individual [ ] $10 Student [ ] $15 Senior (65+)
[ ] $75 Family [ ] $100 Sustaining [ ] $150 Institutional
[ ] $7500 Sponsor
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!
