Contribute to the Hester Pookes Tradescant Fund

____________ Please accept my donation to the Hester Pookes Tradescant Fund for the Preservation of the Museum of Jurassic Technology. I am compelled to contribute:
____________

Backer Contribution	Backers receive a t-shirt with The Hester Pookes Tradescant Fund logo	$50
Exponent Contribution	Exponents will receive a limited edition ceramic plate.	$100
Adherent Contribution	Adherents will receive a minted bronze Museum medallion.	$150
Apologist Contribution	Apologists will receive a minted silver Museum medallion.	$500
Enthusiast Contribution	Enthusiasts will receive a minted gold Museum medallion and a limited edition ceramic plate commemorating their contribution.	$1000
Defender Contribution	Defenders will receive a minted gold Museum medallion, a limited edition ceramic plate commemorating their contribution and an undisclosed special gift.	$5000

Name: (required)

E-mail address:

Phone number:

Street address:

City:

State or Province:

Postal Code:

Country:

Payment: Check or Money Order
Visa or Mastercard

Please send U.S.A. currency if you are paying by check or money order.
Fill out the following if you are paying online by credit card, or contact the Museum by phone or mail with the information. Please note that this is not a secure server transaction.

Name on card:

Card Number:

Expiration Date:

Comments:

_________________

Title Page

Name: (required)
E-mail address:
Phone number:
Street address:
City:
State or Province:
Postal Code:
Country:
Payment:	Check or Money Order Visa or Mastercard
Please send U.S.A. currency if you are paying by check or money order. Fill out the following if you are paying online by credit card, or contact the Museum by phone or mail with the information. Please note that this is not a secure server transaction.
Name on card:
Card Number:
Expiration Date:

Comments:

__ _____________________ __

__ _____________________ __

_________________

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