Explorit Science Center Donation Form Last name: ____________________________________ First name(s): ____________________________________ Title:____________________________________________ Business (if relevant)____________________________________________ Street address: ________________________________________________ Town, State and Zip: _____________________________________________ Daytime phone: (_______)_________________ Please Call me about the following marked items: ___ I am interested in The Benefactor Society for annual gifts. ___ I am interested in planning a bequest to benefit Explorit ___ I would like to donate to one of the Special Funds ___ I would like to discuss an unrestricted donation to benefit all programming ___ I would like to know more about targeting a gift to a specific program ___ The Creative Products idea appeals to me. I think I might be able to help ___ I'd like to know more about sponsorship of the Corporate Science Challenge Or: Please find enclosed: $___________ and direct my donation to ________________________________________ Signature____________________________________ Date:_______________ Referring URL: www.explorit.org/about/donor_printform.html