Please consider me a Friend of the Delta Blues Museum


Name or Company Name __________________________________________________


Address _______________________________________________________________


City _________________________ State _________________ Zip ____________



Individual           Corporate          Honor or Memorial

__ Student $15       __ Donor $250      __ I'd like my gift of $ ______
__ Friend $25        __ Partner $500       to be in the honor of:
__ Family $35        __ Sponsor $1,000
__ Contributor $100                     Name __________________________
__ Patron $250
__ Sponsor $500                         Address _______________________
__ Benefactor $1,000
                                        City ________________ State ___

                                        Zip Code ______________________



Method of Payment

__ My check to the Delta Blues Museum is enclosed

__ Please bill my company

__ MasterCard or Visa


Card Number ______________________________________ Exp. Date __________

Signature _____________________________________________ Date __________



To charge or make your gift by phone, please call John Ruskey or Nancy
Kossman at (601) 627-6820.  Contact John Ruskey, Curator, for additional
information.  Gifts to the Delta Blues Museum are tax-deductible per
IRS regulations 501(C)3.