(Please print)
NAME:________________________________________STREET ADDRESS: __________________________________________________________
CITY: ________________________________ STATE: __________
ZIP CODE: ___________
E-MAIL: _______________
The packet is free of charge. If however you would like to enclose a tax-deductible donation to help the project, please fill in the following line. There is no obligation to make a donation in order to request the packet.
I understand that there is no cost for the packet, however I would also like to make a donation to the project in the amount of: _____________________
(Please make checks payable to:
"PA GETTYSBURG MONUMENTS PROJECT")
Mail this form to:
REP. Harry Readshaw
Room 122 South Office Bldg.
Harrisburg, PA 17120-2020