MACC Contribution Form

Name: _______________________________________________________________________

Address: _____________________________________________________________________

Address: _____________________________________________________________________

City/State/Zip Code: _____________________________________________________________

Phone: ( ______ ) __________________________    Fax: ( ______ ) _______________________

E-mail: _____________________________   

Select level of contribution:

_____ Guardian $ ______
_____ Sentinel $500
_____ Advocate $250
_____ Patron $100
_____ Supporter $ 50

Select method of payment:

_____ Enclosed is a check payable to MACC

Bill by VISA _____ MasterCard _____ AmEx _____
Card# ___________________________________
Expiration Date ____________________________

Midwest Art Conservation Center is a 501(c)(3) non-profit organization. Gifts are tax deductible to the extent that the law allows. Federal tax ID 41-1312834. Many employers will match employee charitable donations. Please check with your employer to further increase the power of your contribution.