Rural Renaissance Network - Renewing the Countryside | Printable Donation Form

I want to support the rural renaissance. I am enclosing my tax-deductible gift of: ___ $10 ___ $25 ___ $100 ___ $250 ___ $500 ___ Other $______ ___ My check is enclosed. Please make check out to "Renewing the Countryside" and note the "RRN" program on the check. ___ Please bill my:  ___ MasterCard    ___ Visa Account Number___________________________ Expiration ___/__ Authorized Signature ______________________________________ ___ I would like to support the Rural Renaissance Network program of Renewing the Countryside in 12 installments of $______ each. Please deduct this amount every month from my ___ MasterCard   ___ Visa Account Number___________________________ Expiration ___/__ Authorized Signature ______________________________________ Name ______________________________________ Address ______________________________________ City, State/Province/Zip Code ______________________________________ Telephone Number ______________________________________ E-mail ______________________________________ Return this form to: Rural Renaissance Program Renewing the Countryside, Inc. 2105 First Av South Minneapolis, MN 55404