Annual Contributor Form

If you wish to use a credit card click, go to our secure online donation page.
 Please use this form for checks.  Please print this form and mail.

Friend  ($35 - $84)	Benefactor  ($600 - $999)
Supporter  ($85 - $174)	Philanthropist  ($1,000 - $2,499)
Patron  ($175 - $299)	Guarantor  ($2,500 - $4,999)
Sponsor  ($300 - $599)	Land Steward ($5,000 or more)

Annual OLT Contribution Amount      $ ___________
o Check here if you wish your donation publicly acknowledged.

Joining The Naturist Society (TNS)?     $ ___________
Click here for more details about TNS membership.

Total Enclosed                                       $ ___________
o Check enclosed made payable to Orient Land Trust.

Donations and benefits apply to both adults in one household.

Print Name ____________________________________________________________

Second Adult of Household ________________________________________________

Address _______________________________________________________________

City, State & Zip _________________________________________________________

E-mail Address _________________________________________________________

Thank you!!  Please mail to:

Orient Land Trust
PO Box 65
Villa Grove, CO  81155-0065

Donations to Orient Land Trust are tax-deductible under
Section 501(c)(3) of the Internal Revenue Code.
You will be sent a receipt.
See Privacy Notice.

Need help?  Call 719-256-4315  9:00 AM - 10:00 PM