WLT Gift Form

Gift Memberships to the Washtenaw Land Trust

Your gift helps protect our region's natural areas and open spaces. Thank you for your generosity. To give a gift membership, please print and mail this form to: Washtenaw Land Trust, 1100 North Main Street, #203, Ann Arbor, MI 48104
Your information:
Name
Address
City/State/Zip
Phone		Email
Gift recipient information:
Name of recipient
Address
City/State/Zip
Donation Amount Enclosed:
	$30 Individual		$500 Sustainer
	$50 Family		$1000 Land Conservator
	$100 Friend		Other: $___________
	$250 Champion
Please make checks payable to the Washtenaw Land Trust, or to donate by credit card:
Visa MasterCard American Express Discover
Card Number		Exp.Dt. (Month/Year)
Donation Amount	$	Signature
Questions? Please contact us at 734.302.LAND(5263) or info@washtenawlandtrust.org.

Please mail this form to:
Washtenaw Land Trust • 1100 North Main Street, #203, Ann Arbor, MI 48104

Thank you for your investment in protecting land!