The Granite Society Pledge Form

1. Donor Information:
Name: ____________________________________ Email: _________________________________
Address: __________________________________ City, State, Zip: __________________________
Phone #: __________________________________

2. Billing Information:
I plan to make this contribution in the form of: check credit card
Name on Card: _____________________________ Credit Card Type: ________________________
Credit Card #: ______________________________ Expiration Date: _________________________
Address: __________________________________ City, State, Zip: __________________________
*Please make all checks payable to USCA

3. Acknowledgement Information:
Please select 1 option from the following:
Please use the following name(s) in all acknowledgments: __________________________________
I (we) wish to have our gift remain anonymous.

4. Pledge Level Selection

Please select your donation level and fill in the supporting questions highlighted in red:
 BEDROCK • $1,000— 100 founding spots
 Genuine Ailsa Craig granite curling gift stone (45mm)
 Access for two (2) people to the USA Curling National Championships
 Special opportunities to purchase VIP tickets to select curling events around the country
 Shirt Size (S-XL): __________

 STONE MASON • $2,500—40 founding spots

 Genuine Ailsa Craig granite curling gift stone (75mm)
 Access for four (4) people to the USA Curling National Championships
 Special VIP experiences at USA Curling National Championships
 Jacket Size (S-XL): _________
 Please select: Pay $2,500 in full (OR) 2 payments of $1,250

 KEANIE CIRCLE • $5,000—20 founding spots

 All the benefits of Stone Mason
 Genuine Ailsa Craig granite curling gift stone (90mm)
 Access for six (6) people to USA Curling National Championships
 Special VIP experiences at U.S. Olympic Team Trials for Curling
 Jacket Size (S-XL): _________
 Please select: Pay $5,000 in full (OR) 3 payments of $1,667
 Designate where your gift goes: ________________________________________________________
 RED TREFOR CIRCLE• $10,000—10 founding spots
 All the benefits of Keanie Circle
 Genuine Ailsa Craig granite curling gift stone (full size)
 Access for ten (10) people to USA Curling National Championships
 A personalized plaque recognizing your commitment to USA Curling
 Jacket Size (S-XL): _________
 Please select: Pay $10,000 in full (OR) 4 payments of $2,500
 Designate where your gift goes: ________________________________________________________

 BLUE HONE CIRCLE • $25,000—4 founding spots

 All the benefits of Red Trefor Circle
 Access to other VIP opportunities not available anywhere else
 Special opportunities for VIP experiences at Olympic Games and World Championships
 Jacket Size (S-XL): _________
 Please select: Pay $25,000 in full (OR) 5 payments of $5,000
 Designate where your gift goes: ____________________________________________________

 AILSA CLUB • $100,000—5 founding spots

 All the benefits of the Blue Hone Circle
 Opportunity for an escorted VIP trip to Ailsa Craig in Scotland, where you will be able to personally
select a piece of granite to have crafted into your own keepsake curling stone
 Suit Jacket Size (S-XL): _________
 Please select: Pay $100,000 in full (OR) 5 payments of $20,000
 Designate where your gift goes: ________________________________________________________

5. Form Submission Details

Please submit this completed form via mail, email, or fax:
 MAIL: USA Curling
Attention Rick Patzke
5525 Clem’s Way
Stevens Point, WI 54482

 EMAIL: rick.patzke@usacurl.org
 FAX: 715-344-2279

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Signature Date