The Entomological Foundation
 

Here is my tax-deductible cash gift or pledge of:   

$500       $400         $200      Other__________

During 2004, I would like to pay my pledge: (please circle your preference):

1) Quarterly

2) All at once. Please send me a reminder notice during (month): __________

3) Bi-annually

Name/Organization________________________________________________________________________________________   (As you would like it to appear in the Annual Report)

Address_______________________________________________________________________________________________

City, State, Zip_________________________________________________

Daytime Telephone __________________________

Mail:
Please make your check payable to The Entomological Foundation and mail along with this contribution form to: The Entomological Foundation, 9332 Annapolis Road, #210, Lanham, MD 20706

 Fax:
 Fax your pledge form to Melodie Dziduch, Administrative Assistant, (301) 459-9084


 THANK YOU FOR YOUR SUPPORT

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