Contact Information *

Please provide the following information for the donor purchasing the commemorative bench.

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Donation Type *

Donation will be collected after receipt of this completed form. Payment can be made in the form of cash, check, or credit card to the National Bonsai Foundation. Your donation is tax deductible to the extent allowed by law.

$6,000 – 71" Linear bench, placed outside in the Upper or Lower Courtyards

$5,000 - 47" Stratus bench, placed inside the Special Exhibits Wing

Alternate Contact Information *

In case the National Bonsai Foundation cannot reach the donor listed above after the bench's retirement in 15 years, please provide an alternate contact below.

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country