Donor Information

	First Name
	Last Name
	Street Address
	City, State,    Postal Code, Country
	Phone
	Email Address

Bookplate Information

	My gift is
	Name on Bookplate    (First Middle Last)
	Occasion
	Message on Bookplate    (80-character limit)

Notification Information

    Please send notification of my gift to:

	Name    (First Middle Last)
	Street Address
	City, State,    Postal Code, Country
	Relationship to Donor

Payment

	Number of Books
	Total Amount    (at $150 per book)

Payment Method

Check (indicate "Honor with Books" on the memo line of the check) Credit card (please call with credit card info:607-253-3510)