DONATION FORM The Fields For Our Future, Inc. committee would greatly appreciate and strongly encourage your generous support of the Pella Sports Park Project . Financial contributions to this project can be made a variety of ways, and over a time span of up to 5 years. Commitments reaching certain amounts are el igible for certain types of recognition, as noted below. T o fill out this form, please fill in the white boxes in the tables below. Please enter your contact information below: E-MAIL: [email protected] • WWW.FACEBOOK.COM/PELLASPORTSPARK PELLA SPORTS PARK PROJECT BUILDING COMMUNITY THROUGH SPORTS T o donate, please send this completed form, along with your first payment (if desired) to this address: Fields For Our Future, Inc. Attn: Pella Sports Park Project P.O. Box 838 Pella, IA 50219 Checks can be made out to “Fields For Our Future, Inc”. Fields For Our Future, Inc. is a 501(c)(3) non-profit corporation and charitable donations are tax deductable as allowed by law. We may be publishing a donor list with levels of giving. Please check if you do not wish to be listed. DONATION TOTAL AMOUNT 2016 2017 2018 2019 2020 RECOGNITION LEVEL* $25,000 $5,000 $5,000 $5,000 $5,000 $5,000 Platinum** $10,000 $2,000 $2,000 $2,000 $2,000 $2,000 Platinum $5,000 $1,000 $1,000 $1,000 $1,000 $1,000 Gold $2,500 $500 $500 $500 $500 $500 Silver $1,000 $200 $200 $200 $200 $200 Bronze WRITE IN See Above Signature Do you intend to submit a “matching funds request to your employer? If “yes,” who is your employer? YES NO NAME ADDRESS CITY ZIP CODE PHONE NUMBER E-MAIL ADDRESS * Recognition Levels will be listed by donor name and displayed on a plaque at the facility. ** Naming Rights are available for donations of $25 ,000+ (please email us for details).