sports museum boosters

$25.00 donation per plate size equivalent

Name engraved on a “Booster Plaque” located on museum wall

$25 for l plate of two lines…$50 for four lines…..$75 for six lines, etc.

Donation amount= $____________   # message lines_________

Engraving on plate size is according to donation amount.

In honor of, In memory of, etc.

One plate equals a maximum of 20 characters including spacing

To be engraved:

engraving plate size is determined by the donation amount.  Space area will correspond to the amount of the purchase.

Check number_____     Check payable to: RRC 
(note on check:  For PCSM)  

Date__________                                                                                                                                                               

Please return this form with your check to:             Dr. Mike Teets

                                                                    260 Deerfield Circle

Questions: 304-288-9590                                        Kingwood, WV 26537