Beach Watcher Gift Form

Please make checks payable to L.E.P. and mail with this form to:

Lighthouse Environmental Programs

c/o WSU Extension

P.O. Box 5000, Coupeville, WA 98239

Enclosed is my tax-deductible donation, payable to L.E.P., for:

____$25 ____ $50 ____ $100 ____ $200 ____ $500 ____ Other

PLEASE PRINT CLEARLY OR AFFIX A RETURN MAILING LABEL

Your name: ____________________________________Phone:______________

Address:__________________________________________________________

City:_________________State __________ ZIP _______ E-mail ____________________

May we list your name as a contributor? Yes or No (please circle)

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

PLEASE COMPLETE THE FOLLOWING

IF THIS IS A MEMORIAL OR LIVING MEMORIAL

This gift is a Memorial or Living Memorial (please circle one) in honor of

Name of person being honored __________________________________________

If a Living Memorial, what is the occasion? __________________________________

(For example: 50^th birthday, 25^th wedding anniversary, retirement)

Please acknowledge this memorial with a card to:

Name___________________________________________________________

Address_________________________________________________________

City_______________________________ State _________________ ZIP_______________

Please make checks payable to L.E.P. and mail with this form to:

Lighthouse Environmental Programs

c/o WSU Extension

P.O. Box 5000, Coupeville, WA 98239