Pledge Form

Pledge Form

For the Viroqua WPA Bathhouse Welcome Center into the Viroqua Visitor Center
I/We wish to make a pledge of the following $ per year over 3 years for the renovation of the Viroqua WPA Bathhouse into the Viroqua Welcome Center*
$ per year over three years
For a total pledge of:
I/We will contribute our donation annually in the month of
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Contributions may be made:

Online at www.viroquaareafoundation.org

By check payable to The Viroqua Area Foundation with a notation that the gift is for the Viroqua WPA Bathhouse Project

Please mail your check to:
The Viroqua Area Foundation
P.O. Box 262
Viroqua, WI 54665
Signature*

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Date (Note: year must match year of first payment)*

MonthDayYear
Date
Thank you for your committment to this project!
Your contributon is tax-deductible to the fullest extent of the law.
Should be Empty: