Donor Form

Make Checks Payable to: ENA

_____ Check here, if donation is for the Continental Bioregional Congress campaign.

 Mail to:

ENA, ATTN: Kailash
64001 County Road DD
Moffat, CO 81143 USA

For more information, please contact:

Kailash
Phone/Fax: (719) 256-5514
webmaster@ecovillage.org

From:

Name:

Address:

City/State/Code:

Country:

Phone & Fax:

eMail:


A receipt will be sent to you by mail qualifying this donation for tax deduction.
Complimentary copies of ENA's electronic newsletter,
Ecovillages,
are mailed to donors with eMail addresses.

Donor Categories
0 Category Amount
0 Friend $1 - $499
0 Contributor $500 - $2,500
0 Supporter $2,501 - $5,000
0 Sponsor $5,001 - $10,000
0 Sustainer $10,001 - $25,000
0 Benefactor $25,001 and over

Amount Enclosed: ___________________

Signature: __________________________________


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