Name Address City St Zip Phone Email Please indicate

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Name Address City St Zip Phone Email Please indicate Powered By Docstoc
					                       Yes! I would like become a member of
                Mesa Land Trust and help preserve our community’s
              agricultural lands, wildlife habitat, and scenic landscapes.

Name ______________________ Address ______________________________

City, St. Zip _______________________________________________________

Phone _________________________ Email ____________________________

Please indicate amount:
Circle One: $25 – Member             $250 - Donor
            $50 – Supporter          $500 - Patron
            $100 – Friend            $1000 – Grand Mesa Benefactor

Please return form with check or complete credit card information below or
visit our website to make a secure online donation.

Charge $____________ to my □ VISA □ MC □ Discover □ AMEX
Name as it appears on card ___________________________________________
Card # _______________________________ Expiration Date _______________
CVV2#_______________ (see back of card – 3 digit security code following Card#)
Signature _______________________________ Date ______________________

I would like to become a Monthly Sustaining Partner and provide a stable
source of monthly income for Mesa Land Trust. To enroll, visit our website
and click the Giving First DONATE NOW button and click on the recurring
donation option or check below and someone will call you to help you enroll
and set up a recurring donation.

  Please have someone from Mesa Land Trust call to help me enroll as a
Monthly Sustaining Partner.

                         Thank you for your support!

                              Mesa Land Trust
                                 1006 Main St
                           Grand Junction, CO 81501

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