MOUSE RIVER PARK GAZEBO

(I/WE) ___________________________________________WOULD LIKE TO MAKE A CONTRIBUTION TO THE MOUSE RIVER PARK ASSOCIATION IMPROVEMENT FUND FOR THE BUILDING OF A GAZEBO IN THE AMOUNT OF $_____________.

CIRCLE ONE:

CASH

MEMORIAL IN THE HONOR OF: ____________________________________________________

PLEDGE TO BE PAID ON OR BEFORE 05-01-07.

SIGNED: ________________________________________________

Make check payable to Mouse River Park Association Improvement Fund.

Contact Person: Delano Granrud, 161 Coles Road, Tolley, ND 58787