Adams County Historical Society

Donations Form

 

Simply print this form and fill in all pertinent information. Then mail to the address listed below.

Date: __________

First Name: _________________ Last Name: _____________________________

Address: __________________________________________________________

Address: __________________________________________________________

City: ____________________________ State: _______________ Zip: _________

Telephone: ____ - ____ - ______

E-mail Address___________________________

 

Please accept my donation in memory of: __________________________________

 

Donation Designation:

[ ] - Buildings & Grounds

[ ] - Archives

[ ] - McGowan Artifact Acquisition

[ ] - Other: ________________________________________________________

 

Amount enclosed: $_____________

[ ] Check

[ ] Money Order

 

Return Receipt Requested:

[ ] Yes

[ ] No

Make payable to:

Adams County Historical Society

P.O. Box 264

Friendship, WI 53934

Please do not send cash through the mail. Checks and money orders are recommended for your safety.
We would like to thank you again for your tax deductible donation.

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