To honor or memorialize a friend, colleague, or loved one, please complete this special gift form. Your honoree or their family will receive a lovely tribute letter and the name of your honoree will appear in our annual report.  To make your gift, please print and complete this gift form, then mail it to us with your payment to the address shown below.

Honor and Memorial Gift Campaign
Piedmont Land Conservancy
 P.O. Box 4025
Greensboro, NC 27404-4025

Yes, I wish to make a gift in honor or memory of a special person to support Piedmont Land Conservancy.  I understand that this gift will help preserve natural and
 scenic lands, farms and green spaces in the Piedmont area of North Carolina 
to enrich the quality of life for our community and for future generations.  

$35 Friend $250 Steward ________ Other
$60 Patron $500 Conservator
$125 Protector $1000 Piedmont Lands Society

Name ________________________________   Phone _______________

Address ___________________________________________________

City ________________________________  State ______  Zip _______

E-mail Address ___________________________________________

      My gift is in memory of: ____________________________________

       My gift is in honor of: _____________________________________

Please send notification of this gift to:

       Name ______________________ Address _____________________

       City _______________________________  State ______ Zip ______


_____ Check enclosed, payable to Piedmont Land Conservancy

____ VISA ____ Master Card # ________________________

Signature ____________________  Expiration Date ________

For faster service, use your credit card 
and fax your order to us at 336-691-0044

Thank You!

Financial information about this organization and a copy of its license are
available from the State Solicitation Licensing Branch at (919) 733-4510. 
This is not an endorsement from the state.