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Thank you for helping Crazy Horse Memorial. Please print this form and fill
in the information. Please mail the completed form and your gift to the address
listed below.
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Name: |
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Address: |
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City: |
State: |
Zip: |
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E-mail address:
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Amount of your gift: $________________________ |
$42
(or amount you wish)
$174
$250
$500
$1,000 or more
$1,500
$2,500-$4,999
$5,000 or more
$10,000 or more |
Grass Roots Club
Korczak's Club
Driller's Club
Blaster's Club
Ruth's
Club
Bronze Club($1,200 IRS deductible)
Granite Club
Crazy Horse Circle
Crazy Horse League |
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For credit card gifts only, please also complete the following:
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Card Number: |
| Expiration Date: |
| Signature of cardholder: |
Send your contribution with this form to:
Crazy Horse Memorial Foundation
12151
Avenue of the Chiefs
Crazy Horse, SD 57730-8900
Contributions to the Crazy Horse Memorial Foundation,
a 501(c)(3) organization, are
tax deductible under
current IRS guidelines. EIN: 46-0220678
For more information e-mail:
memorial@crazyhorse.org
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