New Building Fund Donation

Lafayette Lodge #123

816 Emerald Drive

Lafayette, IN 47905

 

Name:             ___________________________________________________

Address:         ___________________________________________________________________

Phone:            _____________________________         

Email:             ___________________________________________


Donations at the following levels will be recognized on a special Donors Display in our new lodge.

$100 -- $249                                  =                     BRONZE Level

$250 -- $499                                  =                     SILVER Level

$500 -- $999                                  =                     GOLD Level

$1,000 +                                          =                     PLATINUM Level

*There are opportunities for larger donations to be recognized by having a particular room or area named in your honor. Please indicate your interest on this form and a member of the New Building Committee will contact you to discuss options in further detail.

 

Enclosed Donation Amount:  $__________________________  (Payable to Lafayette Lodge 123 New Building Fund)


Name(s) to be placed on the display/plaque (for Bronze, Silver, Gold or Platinum level):

______________________________________________________________________________________________

Lodge Use Only:

Paid/Check #                                            __________________________________________________

Recorded on Master Donor List                 __________________________________________________    

TY Sent                                                     __________________________________________________

Plaque ordered                                          __________________________________________________

Plaque received                                          __________________________________________________