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* Please print out and complete this form, then direct it to the address below. *
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Please help CulturalRenewal.org find pledges of support for the renewal of our culture! 

The greater the pledge participation, the greater the support CulturalRenewal can generate
to help renew our culture.  You can help add pledges by letting interested parties know
about CulturalRenewal.org.   

How it works:  To pledge your tax deductible contribution to Cultural Renewal, print out
and complete this form, make your check payable to Cultural Renewal, and direct it to the
address below.  Once your pledge is confirmed, it will be honored (posted upon request) on
our web site’s respective Gratitude for Goodness Sake page.

Select your pledge category:                                                              

___ Renewer           $5 - $24

___ Supporter         $25 - $49

___ Contributor       $50 - 99

___ Advocate          $100 - $249

___ Donor             $250 - $499

___ Sponsor           $500 - $999

___ Patron            $1,000 - $2,499

___ Benefactor        $2,500 - $4,999

___ Investor          $5,000 - $9,999

___ Altruist          $10,000 - $24,999

___ Philanthropist    $25,000 and up!  (___Cultural Renewal may post specific amount.) 

Select your acknowledgement:

___ I prefer my pledge remain anonymous. 

___ I authorize Cultural Renewal to honor my pledge by posting the following name on its
web site’s respective Gratitude for Goodness Sake page with those within the appropriate
category:

(please print clearly)______________________________________________. 

Enclosed is a check for the amount:  $_________________.

We greatly appreciate your pledge of support for renewing our culture.  Witness the impact
of your pledges upon the efforts of Cultural Renewal and its beneficiaries at our web site,
CulturalRenewal.org.

Cultural Renewal
2635 Italy Friend Road
Branchport, NY 14418-9732
U.S.A.