Fossil Discovery Endowment

Your Name *

Address 1 *

Address 2

City *

State *

Zip *

Phone (we will only call you in case there is a problem with your credit card) *

Email (Purchase confirmation will be sent to this address) *

If making a memorial or honoraria donation, indicate the honoree:

If making a memorial or honoraria gift, is there someone we should notify? Please note we will only notify this person of the gift, not the amount. Please provide name and address.

Please contact me with information about making a bequest in my will, establishing a charitable remainder trust, or other deferred giving plan

Yes

Type of Card *

Credit Card Number *

Expiration Date (MM/YY) *

CCV (on back of card) *

Name (If different than credit card)

Address (If different than above)

City, State, Zip (if different than above)

Total Amount you wish to be charged to your credit card. *

Comments, Questions, Special Designations or Additional Details about your Gift
[To give more detailed information email membership@bigbendconservancy.org]

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