DONATION FORM  (For Benefits of Donor Levels, click HERE)

Member Name ________________________________________________________________

Address ______________________________________________________________________

City ________________________________________ State __________ Zip_______________

Telephone___________________________________

E-mail ______________________________________

Corporate matching gift program:
My gift will be matched by:
Company Name _______________________________________________________

___    I am enclosing a matching gift form.

___    You may print my name in appropriate publications.

___    I wish my gift to remain anonymous.

$25               $50               $75                $100               $150               $200

Foundation Level $300

Cornerstone Level $600

Keystone Level $1,200

Capstone Level $2,500

Sarah Benedict Circle $3,500

Foundation Level and above includes one-year Dual-Household Membership in CRS and other benefits.

Method of Payment: Check Credit Card

Amex/MasterCard/Visa # _______________________________________ Exp. Date _________

$ _____________ Amount Enclosed

Make check payable to:
The Cleveland Restoration Society
3751 Prospect Avenue
Cleveland, Ohio 44115-2705
Phone: (216) 426-1000
Fax: (216) 426-1975
www.clevelandrestoration.org

All gifts are tax deductible to the extent allowed by law.