Entomological Foundation

Here is my tax-deductibe cash gift or pledge of $ ____________________

Name/Organization   ______________________________________________________________________________
                                                              (As you wish it to appear in the Annual Report and on our Web Site)

Address: ______________________________________________________ City ___________________________ State____________  Zip _____________

E-Mail: _________________________________________________________

• Please check here ___ if you are making a gift in honor or memory of someone special. State below the special message you would like us to add to the web site in recognition of your colleage, friend, or family member:

Name of person being recognized: ___________________________________

Special message: _________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

Send a note to the following person letting them know a gift was made in honor or in memory:

Name: _______________________________________________________________________

Address: _______________________________________________City __________________ State _________ Zip _________________

How did you hear about the Entomological Foundation?

___ Colleague/Friend   ____ Surfing the Web  ____  Advertisement in: _______________________     ___  Other___________________________________

Please make your check payable to the Entomological Foundation and mail to:

Entomological Foundation

4510 Regent Street

Madison, WI 53705
(608) 232-1410; EIN#52-1756169

Gifts to the Entomological Foundation are tax-deductible to the extent provided by Federal law

THANK YOU FOR YOUR SUPPORT