Heritage On-Line: E-mail Form

The Heritage of San Clemente Foundation A Non-Profit Corporation (714) 369-1299 Associate Application ( please fill in completely)

Name:
Address:
City: State:
Zip:
Phone:
E-Mail: (Required)
Please check appropriate category below.
Friend:
Heritage Friend $20.00 Sustaining Friend $35.00 Family & Small Business Friend $75.00

Sponsor:
Heritage Sponsor $100.00 Visionary Supporter $250.00 Corporate Sponsor $500.00

Founders Circle:
Heritage Preservationist $1,000 Heritage Visionary $2,500
Premiere Heritage Benefactor $5,000 Ole Hanson Heritage Benefactor $10,000

Your Annual Donation is Cumulative for Increased Benefit Levels
Gift Please Notify:
Name:
Address:
City: State:
Zip:
Gift in Memory Of
Name:

We Accept: Mastercard VISA American Express Discover
Name as it Appears on Card:
Card Number
Exp. Date

If you have questions or comments, write them here, we are happy to answer them: