Glide Wildflower Show 2011 "Building for the Future" Thank you for helping us build

Donor Name: _____________________________________________________________________________

name as written here will be used for recognition in printed material Address:  ________________________________________________________________________________

Home/Cell/Bus. Phone:  _______________   Email: _______________________________________________

Amount _____________________________ (any amount is welcome . . . thank you)

please make checks out to:                               Please charge my:      VISA ______    MC  _______ Glide Wildflower Show, Inc.                                                                           acct. #  ______________________________ Exp. Date ________

Billing Address: ____________________________________________

Signature:  ___________________________________________

Mail to:                    Glide Wildflower Show Building Fund                             P.O. Box 332                             Glide, OR  97443