ASIAN PACIFIC WWII ATROCITY MEMORIAL, INC.

(APWAM) – an IRS 501 (c) (3) non-profit organization

 MEMBERSHIP / DONATION FORM

  Name: ______________________________

  Address: ____________________________

  ____________________________________

  Phone No.: __________________________

  E-Mail: _____________________________

All who support the Mission of APWAM are welcome to join.

□   General Member                         Annual Dues      $20

□   Lifetime Supporter Member        Donation  $1,000 & up

AtrocityMuseum Fund

Donations, in cash, securities, goods or services, from individuals, corporations, foundations and estates are welcome.

Seed Money Fund

 □  Benefactor                               Annual Donation  $200

Museum Fund Pledge / Donation

 □   Donation Enclosed ….…..$ ___________________

 □Pledge Amount ……..….$ _________________

 □Please contact us for non-cash donations, etc.

All donations are tax deductible to the extent allowed by Law.

Donor Recognition Levels

  $ 5,000 & up                         Name listed in Program

  $ 100,000 & up                     Name Inscribed in Stone

  $ 1,000,000 & up                  Naming of Exhibition Hall

APWAM will periodically inform its members

on the progress of the museum project.

Please make your check payable to APWAM

and mail with this form to:

Treasurer, APWAM

10901 Barnwood Lane, Potomac, MD20854

(Dues for areas outside of North America will be set separately)

APWAM will periodically inform its members