Please fill out this form to make a contribution to our cause.

Name _____________________________________

Address ___________________________________

Town/City _________________________________

Postal Code ________________________________

I enclose my donation of $__________

I pledge $ ___________ towards the project.

Donor Categories:

All contributions will be given recognition on a plaque in the future interpretive center. Donors, Sponsors and Benefactors will receive a special certificate.

Please check mark one...

[    ]    1. Contributors: $25 - 99

[    ]    2. Friends: $100 - 499

[    ]    3. Supporters: $500 - 999

[    ]    4. Patrons: $1000 - 4999

[    ]    5. Donors: $5000 - 9999

[    ]    6. Sponsors: $10,000 - 20,000

[    ]    7. Benefactors: $20,000 plus

(Min. $25 for tax receipt.)

Please make cheques payable to:

City of Humboldt Water Tower Fund

P.O. Box 821

Humboldt, SK S0K 2A0

Fax (306) 682-3936