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Yes, I/we wish to support the Lobster Institute. Name(s): ______________________________________________ Address: ______________________________________________ ______________________________________________________ Home Phone: _______________ Work Phone: ______________ [ ] Enclosed is a gift of $_______________________ [ ] Please charge $_____________ to my MC/VISA account : #______________________________ Exp. _____________ [ ] I/we wish to pledge $__________________ to be paid in #____ of installments. Please send reminders [ ] quarterly [ ] bi-annually [ ] annually [ ] My employer will provide a matching gift. I will send forms separately. Industry contributors of $100 or more can be listed in our Website's "Industry" section, with contact information and a link to their Web site. [ ] I would like my company listed with the following contact information and Web address. Company name: _________________________________________ Address: ____________________________________________ Phone: ______________________ Fax: ___________________ Web address: _______________________________________ Signature:___________________________________________ Date: _________________________ Complete and mail this form to: Friends of the Lobster Institute 210 Rogers Hall University of Maine Orono, ME 04469 or call 207-581-1443. |
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