PCEC Mail-in Contribution Form
Your Name:
Your Address:
Your City:
Your State:
Your Zip:
Your Phone:
Your Email:
$1000 Donor
$500 Patron
$250 Sponsor
$100 Contributor
$50 Family
$25 Individual
$Other
Business Council (please complete Business info for recipient below)
Honorary Gift for (please complete info for "Recipient" below)
Gift Membership (please complete info for "Recipient" below)
T-Shirt/s (please complete info for "Recipient" below)
Volunteer Skills (please list areas of interest in the “notes or comments” area below)
Send a newsletter to a friend (please complete info for "Recipient" below)
Send information about Planned Giving options to (please complete info for "Recipient" below)
Recipient Name:
Recipient Address:
Recipient City:
Recipient State:
Recipient Zip:
Recipient Phone:
Recipient Email:
Notes or Comments
Type your notes or comments here
Contact Jim Barrett with questions.
406.222.0723 (local)
866.829.2059 (toll free)
envirocouncil@imt.net
Send this form with your contribution to:
Park County Environmental Council
P.O. Box 164
Livingston, MT 59047