MASSACHUSETTS CENTER FOR NATIVE AMERICAN AWARENESS, INC.

Celebrating Its 25th Year Anniversary!

Campaign Donation Form

Name: ___________________________________________________________________________________________
Address: _________________________________________________________________________________________
City: ___________________________________________________________ State____________Zip _____________
E-mail:_____________________________________________________ Phone: _______________________________

Im honored to partner with you on the 25 Year Anniversary Campaign of the Mass. Center for
Native American Awareness by donating $250.00 which will include my message or my name on
a leather strip attached to the Anniversary Staff.
Id like to pay by:
Check Im enclosing a check for $250.00.
Check - Im enclosing a check for $25.00 and commit to sending a check each month for a total of 10 months.
Credit/Debit Card
Type of card:
___ Visa
___ MasterCard
Name on Card: _______________________________________________________________________________
Card Number: ________________________________________________________________________________
Expiration Date: ______________________________________________________________________________
I authorize Mass Center for Native American Awareness to debit my card for a one-time donation of $250.00
I authorize the Mass Center for Native American Awareness to debit my card each month for $25.00 for a total
of 10 months
Im making an on-line donation of $250.00 through my PayPal account
Im unable to participate in the 25 Year Anniversary Campaign but Im enclosing a donation of $__________
On the leather strip for the Anniversary Staff, Id like my name or my message to read as follows:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Please make checks payable to: Mass Center for Native American Awareness
Mail to:

Mass Center for Native American Awareness

ATTN: 25 Year Anniversary Campaign
P.O. Box 5885
Boston, MA 02114-5885

Massachusetts Center for Native American Awareness, Inc. * P.O. Box 5885 * Boston, MA 02114-5885
617.642.1683 * www.mcnaa.org * mcnaa@aol.com