Donor Form
Northern
Michigan Amateur Radio
Emergency Services
"NMARES"
Date - YY/MM/DD
________________________
Call Sign ___________________
Name _______________________________________________________
Company Name _______________________________________________
Address _____________________________________________________
City, State, Zip Code + 4 _________________________________________
Area Code and Telephone Number (________)
______________________
Email address(s) __________________________________________________
Cash Amount of Donation ________________________________________
Other Donation Description ________________________________ Cash
Value ________
Donation of Goods & Services Describe ______________________ Cash
Value ________
Do you wish to remain anonymous regarding this donation? Yes
___ or No ___
May we list your name call sign or company on our web site donor
page? Yes __ or No ___
Thank you for your generous donation!
Please mail this completed form with your donation to the address below
Northern Michigan Amateur Radio Emergency Services
C/O James E. Davis - KC8NTE
8378 VanTyle Road
Elmira, MI. 49730 -9717