5th National Black Land Loss Summit
"Controlling Our Destiny from the Land to the Man"
February 7-9, 2003
Dudley Inn & Conference Center900 E. Mountain Street, Kernersville, NC 27284
Phone (336) 996-2030, Fax (336) 996-4261
NAME_______________________________________TITLE_____________________
ORGANIZATION________________________________________________________
ADDRESS______________________________________________________________
CITY/STATE________________________________ZipCode_________
PHONE ______________________________FAX____________________________
E-MAIL_________________________________________________________
FOUR TYPES OF SUPPORT
·
Sponsor ($1,000 and up) $___________·
Contributor ($100 to $499) $_________·
Supporter ($500 to $999) $_________
·
Endorser ($1 to $99) $___________
TOTAL AMOUNT ENCLOSED $_______________
Please make checks/money orders payable to: Land Loss Fund,
P.O. Box 61, Tillery, NC 27887Contact Gary R. Grant at 252/826-2800 or via e-mail at mailto:TILLERY@aol.com