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Panther Creek Valley Foundation
No.9 Mine and Museum
9 Dock Street
P.O. Box 287
Lansford,
Pa. 18232-0287
(570) 645-7074
Donor Information
Name:________________________________________
Street Address:________________________________
City:_________________________
State:________________________
Zip Code:____________
Telephone:___________________
Is This A MEMORIAL Donation? ___ Yes / ___ No
If a MEMORIAL, in who's memory is this donation being made:
_______________________________
Type Of Donation
Monetary Donation: $_________
Equipment or Artifact Donation: __________________
Other (Please List) _____________________________
______________________________________________
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