Please print this form and send it along with your donation
to:
Music Maker relief Foundation, Inc
4052 Summer Lane
Hillsborough, NC 27278
Email: mmrf1@aol.com
Tel:919 643 2456
Fax:919 643 2597
Premiums available for your tax-deductible donations:
Donation (no premiums, entirely deductible). All donations of $20
or more include one year
subscription to M.M.R.F. newsletter.
16" x 20" reproduction of photograph of David
Johnson's hands by Axel Kustner (quality suitable
for framing). $20 Photo reproduction ($15 tax deductible).
Willa Mae "The Snake Lady" Buckner Tee
shirts $25 each ($15 tax deductible), sizes L and XL
(circle size)
Guitar Gabriel, Vol 1, A Living Past and
Came So Far CDs $25 each ($15 tax
deductible), $45 for
two ($25 tax deductible), $65 for three ($35 tax deductible)
includes one year subscription
to M.M.R.F. newsletter. (Circle CD of choice)
Captain Luke art. One of a kind ashtrays, hand crafted from
recycled aluminum cans and other
found materials. $100 or more ($75 tax deductible).
Hand painted Guitar Gabriel necktie by
outsider artist Sam McMillan of Winston-Salem, North
Carolina. $250 ($200 tax deductible).
Captain Luke art. One of a kind cars, hand crafted from recycled
aluminum cans and other found
materials. $1000 or more ($900 tax deductible).
Total Donation:__________________ (no charge for shipping in US,
International donors please
add $5 US)
Note: due to IRS regulations the entire amount of a donation is
reduced by the retail value of
premiums received by donors.
Name:_______________________________________________
Shipping Address:______________________________________
____________________________________________________
____________________________________________________
Billing Address:________________________________________
____________________________________________________
____________________________________________________
Telephone (optional):__________________________(day or eve,
circle one)
Fax:___________________ E-Mail:_______________________
If you would like to make your donation by Mastercard or Visa you
may:
call us at: 919 643 2456 (M-F 9-5 EST)
fax us at: 919 643 2597 (anytime)
e-mail us at : mmrf1@aol.com
or write to the address below
Mastercard / Visa (circle one) #___________________________
exp date :_________________
____________________________________________________
(print name)
____________________________________________________
(signature)
Or send check or money order to:
Music Maker Relief Foundation, Inc.
4052 Summer Lane
Hillsborough, NC 27278
Music Maker Relief Foundation, Inc., 4052 Summer Lane, Hillsborough, NC
27278
Email: mmrf1@aol.com
Tel:919 643 2456 Fax:919 643 2597
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