 Please
return this form and your donation at your earliest convenience to:Illinois Professional Land Surveyors Association 203 South Walnut Street P.O. Box 588 Rochester, IL 62563-0588 |
|
Please
return this form and your donation at your earliest convenience to: Illinois Professional Land Surveyors Association 203 South Walnut Street P.O. Box 588 Rochester, IL 62563-0588 |
Individual or Firm
Name__________________________________________________________________
Street or P.O.
Box______________________________________________________________________
City_______________________________________________ State_________
Zip__________________
Phone__________________________
Email_________________________________________________
| Yes, I (we) would like to be recognized as a Gold Compass Donor ($3,000 or more). My (our) check is enclosed for (please specify) | $________ |
| I (we) are enclosing a donation to the Lincoln Surveyor Statue Project in the amount of (please specify). | $________ |
| I would like to purchase (prices shown include shipping and handling): | |
| 12-inch Lincoln Surveyor bronze maquette statue _____ statue(s) @ $525.00 | $________ |
| A. Lincoln with Compass and Chain (updated edition) _____ copy(ies) @ $80.00 ea. | $________ |
| Black and white signed Ostendorf print on which the statue is based ______ print(s) @ $135.00 ea. | $________ |
| Black and white unsigned Ostendorf print on which the statue is based ______ print(s) @ $55.00 ea. | $________ |
Total Enclosed |
$________ |
Please make checks payable to IPLSA Lincoln Surveyor Statue Project.