NAME _____________________________________________________

ADDRESS ___________________________________________________

CITY __________________         STATE ________ZIP ________________

TELEPHONE NUMBER   _________________________________________
   
Please accept my tax-deductible contribution of:
    $50    $100    $ 250    $ 500    $ 1,000    Other 

    I have attached the Pledge Agreement; please contact me to confirm specifics.

    Please keep my donation private (donation amounts are always confidential).

    Yes, my company participates with matching funds, please watch for a form from:
   (Company name)


    If the project is not completed, please return my donation (over $ 100 only please)

Please make your check payable to:

Maxwell Conservation Trust

and return to:

Save the River View   
PO Box 100
Scituate, MA 02066

No goods or services have been or will be provided in return for your donation. All contributions are fully tax deductible