* Indicates Required Field
Annual Fund Donation Form

Gift Amount:*

Leadership Circle

$25,000 Chairman's Circle (FMV: $610)

$10,000 Director's Circle (FMV: $610)

$5,000 Gallery (FMV: $225)

$2,500 Fellows (FMV: $200)

$1,500   $1,000   $500   $250   $100   $75  

Other Donation Amount:


$  

How would you like to designate your donation?
To receive benefits related to Bayou Bend or the Glassell School please designate your gift accordingly.

Museum

Bayou Bend Collection and Gardens
          Founder $1,500 (FMV $175) Patron $500 (FMV $150) Friend $200 (FMV $125)

The Glassell School of Art
          SAO Exhibition $1,000 (FMV $150) Workshop $250 (FMV $125) Studio $75 (FMV $50)

Rienzi

Use my gift where it is needed most

After Fair Market Value (FMV) is applied, the remainder of your gift is tax-deductible.

I/we wish to waive all benefits and make this gift 100% tax-deductible.

Special Notes:

Tribute Acknowledgement Information:

I'd like to make this donation

Tribute:


Acknowledgement Name:


Acknowledgement Address:


Acknowledgement E-mail:




Personal Information:

Title:Mr.  Mrs.  Ms.  Miss

Last Name*:


First Name*:


Address*:



Address 2:


City*:



Zip / Postal Code*:
State / Province*:

Country:


E-Mail*:


Name as it should appear in printed materials:



Phone Number*:



Payment Information:

Credit Card Type*:


Expiration Date*:


Credit Card Number*:


Security Code*:



Billing Information:


Same as Personal Information

Title:Mr.  Mrs.  Ms.  Miss

Last Name*:


First Name*:


Address*:



Address 2:


City*:



Zip / Postal Code*:
State / Province*:

Country:



I am/we are interested in receiving information about including the museum in our will or trust, and becoming a member of the Myrtle Wreath Society and/or Ima Hogg Society.


For gifts of stock or securities or for more information about the Annual Fund Drive or Leadership Circle, please contact Anissa Cordova, annual fund manager, 713-639-7559 or acordova@mfah.org.




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2013 The Museum of Fine Arts, Houston