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									                                                                            St. Joe River Basin
                                                                                 The Conservation Initiative

Capital Campaign Pledge Form
DONOR INFORMATION (Please type or print)
Last name: ___________________________ First name: __________________________ MI: ______________________
Address: ______________________________________________________________________________________________
City: ________________________________ State: _______________________________ Zip code: _________________
Home phone: _________________________ Business phone: __________________________________________________
Email: ________________________________________________________________________________________________

I (we) hereby contribute cash and/or assets to the St. Joe River Basin Conservation Initiative Capital Campaign.

I (we) pledge a total of $ ______________ amount enclosed $ _______________ remainder pledged $_______________

I (we) wish to have this donation spread over                1    2      3 year(s)        other

I (we) plan to make my (our) contribution in the form of:
      cash        check        charge        stock       property        other ______________________________
   For stock transfers or property donation, please contact Stephanie Taylor, The Trust for Public Land, 206-587-2447,

Please charge my credit card:           Visa        MasterCard

Credit card number: __________________________________ Exp. date: ________________
Authorized Credit Card Signature: _______________________________________________

Please bill me beginning ________________and thereafter                    monthly        quarterly       yearly       other _____________

My gift will be matched by _____________________________________________ Company/Foundation/Family
      Matching gift form enclosed    Matching gift form will be forwarded to The Trust for Public Land

DONOR RECOGNITION (Donors will be recognized in campaign materials unless an anonymous gift is requested)
Please use the following name(s) in all acknowledgements: ______________________________________
       I (we) wish to remain anonymous

       I (we) have designated The Trust for Public Land in my (our) will/estate planning
       I (we) would like more information about planned giving

Please Make Checks & Corporate Matches Payable To: The Trust for Public Land
Donations are tax-deductible to the extent allowed by law.

Mail your pledge to: The Trust for Public Land, 1011 Western Avenue, Suite 605, Seattle, WA 98104

                Stephanie Taylor                     Northwest Region                    T: 206-587-2447
                Director of Development              1011 Western Ave, Suite 605         F: 206-382-3414
                       Seattle, WA 98104         

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