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Surry County, Virginia, Historical Society and Museums, Inc.
P. O. Box 262, Surry, VA 23883   Phone (757) 294-0404
E-mail address: surryhistoricalsociety@gmail.com.
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Surry County, Virginia, Historical Society and Museums, Inc.

New Building
Architectural Design by C & K Homes, Inc.

The Home of Surry County History

Gift Response Form for the Historical Society Building Fund

Date _______________


Yes, I/ We would like to support the construction of the Historical Society Building with a tax deductible gift of

$_____________________.

__________ My/ Our check for this amount is enclosed.

__________ I/ We would like to make this gift over three years. My/ Our check for 1/3 of the gift is enclosed. The second payment will be made in _____________, 2009. The final payment will be made in _____________, 2010.

__________ I/ We would like a pledge reminder sent to me/ us.

__________ I/ We would like this gift to be anonymous.

__________ I/ We would like to discuss the naming opportunities available with a Society representative. Please call me at ____________________ or email me at __________________


Checks should be made payable to The Surry Historical Society.

Please note on the memo line of the check "Building Fund" and send to:

The Surry County, Virginia, Historical Society and Museums, Inc.
P.O. Box 262
Surry, VA, 23883
Atten: Treasurer

Name _________________________
Address _________________________
_________________________
Telephone_________________________ (optional)



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