Huichol Donor Form

Donation Form

Print this Out and Mail or Fax

To:
The Huichol Center
801 2nd Ave., Suite 1400
Seattle WA 98105 USA
Tel: 206-622-4067
Fax: 206-622-0646
From:
Name:
Address:
City/State/Code:
Country:
Tel:
Fax:

I would like to make a tax-deductible donation to the Huichol Center. I understand I will receive a receipt by mail.

**Huichol Center Donor Categories**
ˆ	Category	Amount
	Donor	$1 - $499
	Contributor	$500 - $2,500
	Sponsor	$2,501 - $5,000
	Supporter	$5,001 - $10,000
	Sustainer	$10,001 - $25,000
	Benefactor	$25,001 and over

Amount Enclosed : ___________________

Please charge my VISA or MASTERCARD

Number: ______ ______ ______ ______ Expires: __________

Signature: __________________________________

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