Donor Form

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Count Me As A Steward of the Potomac Highlands!

Name ________________________________________________________

Street ______________________________________________________

City __________________________ State ____ Zip ______________

Phone _______________________________________________________

Email/Web Site ______________________________________________

Talents/Expertise ___________________________________________

_____________________________________________________________

Areas of greatest concern: __________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

      $25       $50       $100       $250       $500       $ _____

Please circle the amount of your donation (any amount is appreciated!) and mail to:

Stewards of the Potomac Highlands
PO Box 455
Wardensville, WV 26851-0455

Because we are an advocacy group and exercise our rights to lobby to protect our Potomac Highlands your contribution is not tax deductible. Tax deductible donations in amounts of $100 or more can be made out to Friends of the Earth and mailed to our address. Please use the back of this form to send names and addresses of others who may be interested in joining, or if you need more room for your specific ideas and concerns.

Copyright © 2008 Stewards of the Potomac

Highlands, Inc.   All Rights Reserved.