Black Canyon Land Trust

1500 East Oak Grove,

Suite 201

Montrose, CO 81401

Voice: 970/252-1481

Fax: 970/252-7209

email BCLT

"Promoting & ensuring conservation of private lands in the Uncompahgre, North Fork, and Lower Gunnison Watersheds."

BCLT & NSJI Mail-in / Drop-in Support Form

Yes! I want to support the Black Canyon Land Trust / Northern San Juan Initiative (circle one) at the following level:

_______ Supporting ($25-$49)

_______ Sustaining ($50-$99)

_______ Visionary ($100-$249)

_______ Benefactor ($250-$499)

_______ Silver Club ($500-$999)

_______ Gold Club ($1000+)

Name: ___________________________________________________

Address: __________________________________________________

___________________________________________________________

Telephone: ________________________________________________

Email: _____________________________________________________

Black Canyon Land Trust & Northern San Juan Initiative may wish to publish an acknowledgement of our supporters (we will not include the amount of your contribution). If you would prefer that your name not be disclosed, please check here.

Return with your check payable to "BCLT" or "NSJI" by mail or in person to:

Black Canyon Land Trust (BCLT)

1500 East Oak Grove,

Suite 201

Montrose, CO 81401

970/252-1481

or

Northern San Juan Initiative (NSJI)
555 West Clinton Street,
Suite A
PO Box 2052
Ridgway, CO  81432
970/626-3134

Thank You for your support!

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