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<title>Jennings Randolph Recognition Project Contribution Form</title>
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<p align="center"><b><font face="Arial" size="3">
<img border="0" src="images/agrilogo-small.gif" width="100" height="111"><br>
JENNINGS RANDOLPH RECOGNITION PROJECT</font></b></p>
<p align="center"><font face="Arial" size="3">Contribution Form<b> </b></font></p>
<p align="center"><font face="Arial" size="3">
<img border="0" src="images/checkbox-small.gif" width="18" height="17">
Yes! I would like to support the Jennings Randolph Recognition Project<br>
to memorialize the contributions of the Mountain State Senator <br>
whose values inspired the world.<br>
<br>
</font></p>
<div align="center">
<table border="0" cellspacing="1" width="424">
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<td width="104"><font face="Arial" size="3"><b><i>Organization</i></b>:</font></td>
<td width="306"><font face="Arial" size="3">____________________________________________________________</font></td>
</tr>
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<td width="104"><img border="0" src="images/space.gif" width="15" height="14"></td>
<td width="306"></td>
</tr>
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<td width="104"><font face="Arial" size="3"><b><i>Your Name</i></b>:</font></td>
<td width="306"><font face="Arial" size="3">____________________________________________________________</font></td>
</tr>
<tr>
<td width="104"><img border="0" src="images/space.gif" width="15" height="14"></td>
<td width="306"></td>
</tr>
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<td width="104"><font face="Arial" size="3"><b><i>Title</i></b>:</font></td>
<td width="306"><font face="Arial" size="3">____________________________________________________________</font></td>
</tr>
<tr>
<td width="104"><img border="0" src="images/space.gif" width="15" height="14"></td>
<td width="306"></td>
</tr>
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<td width="104"><img border="0" src="images/space.gif" width="15" height="14"></td>
<td width="306"></td>
</tr>
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<td width="104"><font face="Arial" size="3"><i><b>Address</b></i>:</font></td>
<td width="306"><font face="Arial" size="3">____________________________________________________________</font></td>
</tr>
<tr>
<td width="104"><img border="0" src="images/space.gif" width="15" height="14"></td>
<td width="306"></td>
</tr>
<tr>
<td width="104"><font face="Arial" size="3"><b><i>City/State/ZIP</i></b>:</font></td>
<td width="306"><font face="Arial" size="3">____________________________________________________________</font></td>
</tr>
<tr>
<td width="104"><img border="0" src="images/space.gif" width="15" height="14"></td>
<td width="306"></td>
</tr>
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<td width="104"></td>
<td width="306"><font face="Arial" size="3">____________________________________________________________</font></td>
</tr>
<tr>
<td width="104"><img border="0" src="images/space.gif" width="15" height="14"></td>
<td width="306">
</td>
</tr>
<tr>
<td width="104"><font face="Arial" size="3"><i><b>Telephone</b></i>:</font></td>
<td width="306">
<p align="left"><font face="Arial" size="3">____________________________________________________________</font></td>
</tr>
<tr>
<td width="104"><img border="0" src="images/space.gif" width="15" height="14"></td>
<td width="306"></td>
</tr>
<tr>
<td width="104"><font face="Arial" size="3"><b><i>Fax</i></b>:</font></td>
<td width="306"><font face="Arial" size="3">____________________________________________________________</font></td>
</tr>
<tr>
<td width="104"><img border="0" src="images/space.gif" width="15" height="14"></td>
<td width="306"></td>
</tr>
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<td width="104"><font face="Arial" size="3"><i><b>E-mail</b></i>:</font></td>
<td width="306"><font face="Arial" size="3">____________________________________________________________</font></td>
</tr>
<tr>
<td width="104"><img border="0" src="images/space.gif" width="15" height="14"></td>
<td width="306"></td>
</tr>
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<td width="104"><font face="Arial" size="3"><b><i>Signature</i></b>:</font></td>
<td width="306"><font face="Arial" size="3">____________________________________________________________</font></td>
</tr>
</table>
</div>
</center>
<p align="left"><font face="Arial" size="3">Enclosed is my gift of:</font></p>
<table border="0" cellspacing="1">
<tr>
<td width="20%"><font face="Arial" size="3">
<img border="0" src="images/checkbox-small.gif" width="18" height="17">
$50<img border="0" src="images/space.gif" width="15" height="14"></font></td>
<td width="20%"><font face="Arial" size="3">
<img border="0" src="images/checkbox-small.gif" width="18" height="17">
$100<img border="0" src="images/space.gif" width="15" height="14"></font></td>
<td width="20%"><font face="Arial" size="3">
<img border="0" src="images/checkbox-small.gif" width="18" height="17">
$200<img border="0" src="images/space.gif" width="15" height="14"></font></td>
<td width="20%"><font face="Arial" size="3">
<img border="0" src="images/checkbox-small.gif" width="18" height="17">
$500<img border="0" src="images/space.gif" width="15" height="14"></font></td>
<td width="20%"><font face="Arial" size="3">
<img border="0" src="images/checkbox-small.gif" width="18" height="17">
Other ______</font></td>
</tr>
</table>
<center>
<p align="center"><font face="Arial">Donations </font><font face="Arial" size="3">to the Jennings Randolph Recognition Project
(JRRP) </font></p>
<p align="center"><font face="Arial" size="3">are tax-deductible under IRS
Code 501 (c)(3) with checks payable to:</font></p>
<p align="center"><b><font face="Arial">The Agribusiness Council - JRRP</font><font face="Arial" size="3"><br>
P.O. Box 5565<br>
Washington,DC 20016</font></b></p>
<p align="center"><font face="Arial" size="3">Thank You! </font></p>
<p align="center"><b><font face="Arial" size="2">"Building bridges through associations with peoples of the world"</font></b>
<p align="center"><b><a href="randolph.htm"><font face="Arial" size="2">Randolph
Recognition Project</font></a></b>
<p align="center"><a href="enrollment_form_jr.htm"><b><font size="2">Application
Form</font></b></a>
<p align="center"><b> <a href="http://www.Agribusinesscouncil.org/default.htm"><font face="Arial" size="2">Home</font></a></b></td>
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