Newburgh Preservation Association
Dutch Reformed Church Restoration Committee
P.O. Box 206
Newburgh, NY 12551


Name __________________________________


Address _________________________________


City ____________________________________


State ____________ Zip ____________________


Email ___________________________________


Phone _________________ [ ] Days [ ] Evenings


Able to volunteer? _________________________


Skills/Area of interest ______________________

________ Benefactor


$   500 and above
________ Sponsor


$   250 and above
________ Supporter


$   100 and above
________ Household


$     50 and above
________ Individual $     25


Please print this form, make check payable to:
Newburgh Preservation Association
and mail both to the address above.

All levels of support are gratefully appreciated!