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Capital Contribution
to the Northern Pacific Railway Historical Association Qualifying
for Membership in ‘The 1883 Society’ Name(s): ________________________________________________________ Date:
_________________ Address: ______________________________________________________________________________ City:
___________________________________________ State:
__________ Zip: _____________________ In
consideration of the gifts of others, I/we pledge the total sum of: $ ____________________________ First Payment
made with submission of this form ___ or to be made by: __________________________ Equal
payments of: $ ______________ to
be completed within 60 months of subscription or by: _____________________________________________________________________________________ Special
designation for use of Contribution: __________________________________________________ Note: Undesignated gifts will be put into a general
preservation fund. Method of Payment: ___ Check No. _______ ___ Visa /
MC Number: _____________________________________ Exp. Date:
___/___ ___ Please
bill me $ _______________________ annually, until the subscription is
fulfilled. ___ Gift of
Stock/Securities [describe briefly] ________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ___ This commitment is binding on my/our
estate: __________________________ [initial(s) please] ___
In addition to my personal commitment, I anticipate that my employer
will provide a matching grant. Name
of employer: __________________________________________________________ Maximum amount
of matching grant $ __________ Signature(s): _____________________________________________________ Date: ________________ Signature(s): _____________________________________________________ Date: ________________ Thank you. Your membership in The 1883 Society will be recognized in NPRHA publications; however, all details of your contribution will be kept confidential. ___ I/We wish to remain anonymous. Please Note: Gifts to the Northern Pacific Railway Historical Association, a 501(c)3 organization, are fully tax-deductible, in accordance with the law. Charter__ Member No._______ Pin sent_______ |
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