Please consider me a Friend of the Delta Blues Museum Name or Company Name __________________________________________________ Address _______________________________________________________________ City _________________________ State _________________ Zip ____________ Individual Corporate Honor or Memorial __ Student $15 __ Donor $250 __ I'd like my gift of $ ______ __ Friend $25 __ Partner $500 to be in the honor of: __ Family $35 __ Sponsor $1,000 __ Contributor $100 Name __________________________ __ Patron $250 __ Sponsor $500 Address _______________________ __ Benefactor $1,000 City ________________ State ___ Zip Code ______________________ Method of Payment __ My check to the Delta Blues Museum is enclosed __ Please bill my company __ MasterCard or Visa Card Number ______________________________________ Exp. Date __________ Signature _____________________________________________ Date __________ To charge or make your gift by phone, please call John Ruskey or Nancy Kossman at (601) 627-6820. Contact John Ruskey, Curator, for additional information. Gifts to the Delta Blues Museum are tax-deductible per IRS regulations 501(C)3.
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