|
Yes, I want to contribute to Quercus
Review. The amount of my gift is:
$_________
Angel ($2,500+)
$_________
Publisher ($1,000+)
$_________
Litterateur ($500+)
$_________ Scribe ($100+)
$_________
Muse ($50+)
|
|
Name:
_____________________________________
Address: _____________________________________
_____________________________________
City:
____________ State: _____
Zip: __________
Phone:(___)____________________________
Email:_________________________________ |
|
Payment Method
( ) Check Enclosed (payable
to "QR c/o MJC Foundation")
( ) Credit
Card (Visa or
Mastercard only)
CC# _________________________________ Exp. Date __________
If you
would like your contribution to be acknowledged anonymously
in the
next issue of QR, please check here: ( ).
|
|
Please
print, complete, & mail your form to
MJC Foundation
c/o Quercus Review
435 College Ave.
Modesto, CA 95350
Thank you for supporting the literary
arts at MJC. |