MPN Donation Slip

Yes! I wish to contribute as follows (check one):
________Benefactor ($1,000) __________ Patron ($500) ____________Sponsor ($250)
________Contributor ($100) _________Donor ($50) _________Friend $__________

Please Indicate your name as you wish it to appear in our Annual Report
Name___________________________________________________
Address_________________________________________________
City________________ State_____________ Zip_______________
Check here if you do not want to be listed _________