Name _____________________________________________

Address ___________________________________________

City/State/Zip ______________________________________

Phone _____________________________________________

Email Address _______________________________________

Enclosed in my gift of: $_______________________________

Check___  Other_____________________________________

Visa or MasterCard #___________________ Exp Date_______

Signature of Cardholder________________________________

I’d like to receive more information on:

___Granting a conservation easement

___Donating to a particular conservation project

___Purchasing Colorado Income tax credits

___Conservation Buyer Program

___Technical Assistance Program

___Community Education Programs

___Including AVLT in my estate plan or will

Other _______________________________

How did you hear about AVLT?

____________________________________