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Tangipahoa African American Heritage
Museum & Black Veterans Archives
P.O. Box 1631
Hammond, Louisiana 70404
DONATION/PLEDGE FORM
_____ I pledge my support as a Corporate
Partner (Platinum Sponsor) for $75,000 or more.
Exhibit room in Corporation or Individual name.
_____ I pledge my support as a Diamond
Sponsor
for $50,000 or more.
One of two (2) names on a plate in an Exhibit room.
_____ I pledge my support as a Gold
Sponsor
for $25,000 or more.
One of four (4) names on a plate in an Exhibit room.
_____ I pledge my support Individually in the amount of $______________.
_____ I pledge my support in the
form of an In-Kind
donation of the following items:
_______________________________________________________________
Name _______________________
Title
_______________________
Company
_______________________
Address
_______________________
City/State/Zip _______________________
Telephone
_______________________
If
you prefer that we continue correspondence through another contact at
your company on your behalf, please list contact person below:
Contact
Name _______________________
Title
_______________________
Company
_______________________
Address
_______________________
City/State/Zip _______________________
Telephone
_______________________
Fax____________
Email_______________
Do
you wish to remain anonymous?
__
Yes
__
No
Do
you require a charitable donation receipt/income tax receipt?
__
Yes
__
No
Donor Signature:
Date:
Please
forward questions or comments to:
George
Perkins Sr., President
P.O.
Box 1631
Hammond,
Louisiana 70404
Telephone: Office# (985) 345-9134
Fax # (985) 345-5819
Cell # (985) 320-5357
Email
address: tangiafromuseum@bellsouth.net
Thank
You!