P. O. Box 1996
Wapakoneta, Ohio 45895
Now is the time to preserve the History, the Freedom and the Glory of our nation for future generations to enjoy. You can make a difference in preserving our history by supporting the Freedom Field Project.
Yes, I/we would like to make a tax-deductible contribution toward the construction of Freedom Field. Any gift of sixty dollars or more will be recognized with an imprinted brick bearing your Name or that of your designee such as children, grandchildren, parents, aunts, uncles, friends and neighbors, and as a memorial for someone that has passed away. You may have as many bricks as you like. For example, $120 = 2 bricks, $300 = 5 bricks, and so on.
Print this form, fill it out and mail to the address above along with your contribution. Print one form for each brick desired.
Individual/Company/Organization
name making contribution :___________________________________
Address:________________________________________
City:___________________________________________
State:__________________________________________
Zip Code:_______________________________________
Phone (optional):_________________________________
Name To Appear On
Brick:___________________________________ (example – Dave and Sally
Johnston)
Hometown And State:___________________________________(If different than
above)
Contribution for Bricks: $60
times ________ (number of Bricks) = $_________________
I/we would also like to make an additional contribution of:
$100____$500____$1,000____$5,000____Other____
Total Contribution: $________________(ad two lines together)
Please Charge my Contribution to my: (check one) Visa______ or MasterCard______
Account No.: __ __ __ __ / __ __ __ __ /
__ __ __ __ / __ __ __ __
Expiration Date: __ __/ __ __ / __ __
Cardholder Name:___________________________________________ (please print)
Authorized Signature:____________________________________________
Total amount to be charged to my account: $_________________________
You can reach us by e-mail at: freedom@bright.net
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