Name :
Address :
Country :
Donation Amount :

 

Levels of Donation :	Museum Friend $100-$499
	Museum Contributor $500-$999
	Museum Donor $1,000-$2499
	Museum Sponsor $2,500-$4999
	Museum Benefactor $5,000-$9,999
	Museum Lifetime Benefactor $10,000-$24,999
	Museum Major Contributor $25,000+

 

I wish my name to be listed on the Donor Recognition Wall :

Yes     No

I wish to make my donation in honor or in memory of :

Unit / Organization :

Please, send to: Carentan Historical Center 2, Village de l'Amont 50500 Saint-Côme-du-Mont France