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Membership Application for Board of Trustees

For

Major Philanthropists, Benefactors & Celebrities

Quantrek is a 501(c)3 and a 509(a) tax exempt publically supported non-profit organization. We will confirm your membership status via email.

Board of Trustees membership amount and levels:

         Amount / Level

To become a member of the Board of Trustees, please complete the following membership form make your donation online or mail your check to the following address:

Dr. Edgar Mitchell

Quantrek, Inc

PO Box 540037

Lake Worth, FL 33454-0037

 

 

Your online donation is secured by:
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I am interested in making a restricted gift to the Frontier Science Endowment Fund. Please contact me or send additional information.

I would like to make an unrestricted gift to support the work of Quantrek. (Enter the amount you wish to pledge below).

Please send me an invoice for the amount I have pledged to contribute

 Amount pledged           

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*First Name:       

      Middle:         

*Last Name:          

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 *Address1:

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*State / Province:         

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*Commercial and / or industrial affiliation:

   

*Interests:

   

*Institutional Email Address:          

*Personal Email address:          

 Day Telephone:   

 

 Evening phone:    

 

Thank you for your generous support.