BONE ORCHARD Donation form
www.boneorchard.org

NAME:________________________________________________________

ADDRESS: ____________________________________________________

______________________________________________________________

______________________________________________________________

e-mail: (to be notified of future events) ________________________________________________

DONATION AMOUNT*: ______________________________________
(*note: all donations in excess of $1,000 must also be accompanied by the Major
Gift Letter .)

Who should we thank on our future programmes or do you wish to remain
anonymous?

_________________________________________________________________

Please make your check payable to FRACTURED ATLAS and write on behalf of Bone
Orchard in the memo line

Send both the check and this form to:

Bone Orchard
105-24 67th Avenue, #4C
Forest Hills, NY 11375

Thank you!

Fractured Atlas is a 501(c)3 public charity. All donations are tax-deductible to the extent
permitted by law.