Buffalo & Erie County Historical Society
Adopt an Artifact Form

Please print this page, fill it out, and return with payment in U.S. funds to
Buffalo & Erie County Historical Society
24 Nottingham Court
Buffalo, New York 14216-3119

  Name __________________________________________________________________

  Address ________________________________________________________________

  City/State/Zip____________________________________________________________

  Phone ____________________

  E-mail ________________________________________________

If this adoption is a gift, send to:

Recipient's Name __________________________________________

Address _________________________________________________

City/State/Zip _____________________________________________

     Select Your Artifact

  ___ Apostolic Clock ___ Pierce Motorette
  ___ Ararat Stone ___ Porter Sword
  ___ Birds-Eye Map ___ Six Nations Purse
  ___ City Directory ___ Spingarn Medal
  ___ LaFontaine Jersey ___ Steinway Piano
  ___ Madame La Doll    

  

 

 

 

 

   Enter the Amount You Will Donate: $____________

   Method of Payment

     _____ Check enclosed, payable to BECHS

     _____ MasterCard      ______Visa     ________________ Exp. Date

     Card # _______________________________________

     Signature _____________________________________