Corbitt Book

__$1,000 __$500 __$250 __$100 __$50 __$25 Other $______

 Name_____________________________________________

 Address___________________________________________

 City, State, Zip______________________________________

 Please print and fill out this form and enclose  a check made payable to “Corbitt Preservation Association” and mail this form and the check to

Corbitt Preservation Association
PO Box 74
Henderson, NC  27536

Optional:

I would like to make a gift:

 __In memory of _____________________________________

 __In honor of_______________________________________

 Please notify the following person(s) about this gift (if applicable)

 Name_____________________________________________

 City, State, Zip______________________________________

All donors will be recognized in acknowledgements section of book unless you request anonymity. 

Please check if you would like to remain anonymous.______

Thank you for your role in perpetuating Corbitt history!

 Corbitt Preservation Association is a 503(c) (3) non-profit organization.  This donation is tax deductable to the extent allowed by law.