PHEASANT NATION
Conservation & Banded Bird Fund
Contribution Form · Funds the Banded Bird Project, pheasant releases and habitat work
This is a payment form, not the free entry form. No purchase or contribution is necessary to enter or win the HUMMER EV Giveaway. To enter free, use the Official Mail-In Entry Form at pheasantnation.com/free-entry. Contributions are not tax-deductible: Pheasant Nation LLC is a for-profit company, not a charity.
Contribution amount
$10 $25 $50 $100
Other: $ ____________
Contributor information (please print clearly)
First name
Last name
Street address
City
State
ZIP
Email (for your receipt and entries)
Phone
Date of birth (for giveaway entries)
Payment
OPTION 1 Check or money order enclosed, payable to Pheasant Nation LLC. Do not send cash.
OPTION 2 Charge my card Visa Mastercard Amex Discover
Card number
Exp. (MM/YY)
CVV
Billing ZIP
Name on card
Cardholder signature (I authorize this one-time charge)
Giveaway entries (optional)
Credit my contribution with HUMMER EV Giveaway entries (1 entry per $1, once payment clears; max 100,000 entries per person from all methods). I certify that:
I am a legal resident of the United States or DC, and not a resident of New York or Florida, and I am at least 18 (19 in AL and NE, 21 in MS).
I have read and agree to the Official Rules at pheasantnation.com/official-rules.
Optional: send me Pheasant Nation news by email.
Signature
Date
MAIL TOPheasant Nation: Conservation Fund
2028 23 RD
Kearney, NE 68845
2028 23 RD
Kearney, NE 68845
Contributions are paid to Pheasant Nation LLC, a for-profit company. They are not charitable donations, are not tax-deductible, and are non-refundable except where required by law. Contributions go toward the Banded Bird Project, pheasant releases and habitat work. Card details are used only for this one-time charge; the card section is destroyed after processing. Questions: support@pheasantnation.com or 308-223-3411. Prefer online? pheasantnation.com/conservation-fund
OFFICE USE ONLY
Received ____________
Amount $ ___________
Order # _____________
Card section shredded ☐
Received ____________
Amount $ ___________
Order # _____________
Card section shredded ☐