| Name:
____________________________________________________________________
Address:
__________________________________________________________________
City,
State, Zip: _____________________________________________________________
Phone:
___________________________________________________________________
____
I have enclosed my check in the amount of $_______________________________.
____
Please charge my credit card in the amount of $____________________________.
Please
check one:
| ____
Visa |
____
MasterCard |
____
American Express |
| ____
Discover |
____
Diners Club |
|
Account
#: _____________________________________ Exp. Date ___________
Signature:
__________________________________________________________
For donations
of $500.00 or more, you will receive the newly created, hand painted
replica of Lucy, our National Historic Landmark.
Donations
of $1,000.00 or more will entitle you to a "Platinum Peanut"
Lifetime Pass to Lucy and your name inscribed on our Bronze Donor
Plaque to be on permanent display at Lucy.
Your Platinum
Peanut will be engraved in the name above unless otherwise instructed.
Please indicate below how you would like your name inscribed on
our permanent Donor Plaque.
__________________________________________________
(Please
limit inscription to 30 characters, including spaces)
Please
mail to:
The
Save Lucy Committee, Inc.
P.O. Box 3336
Margate, New Jersey 08402 USA
|