| Note: Use your browser's "Print" function to print a copy of this form. After the form is complete, please mail it (along with your check, if applicable) to: |
DANCECleveland
28815 Aurora Rd, Suite 203 Cleveland, Ohio 44139-1858 |
DANCECleveland Annual Fund Campaign
| __ $5,000 and above Leadership Society __ $2,500 - $499 Director's Circle | |||
| __ $1,000 - $2,499 Visionaries | __ $500 - $1,000 Luminaries | __ $100 - $500 Virtuosos | __ $1 - $99 Partners |
Yes, I want to support DANCECleveland!
| ___ I have enclosed a check in the amount of $ ____________________ (made payable to DANCECleveland) | |
| ___ Please charge my credit card $ ____________________ today! [ ] VISA [ ] MASTERCARD [ ] DISCOVER | |
| ___ Credit Card # | Exp. |
|
Please
charge the above pledge to my credit card ______ semi-annually
______ quarterly
starting today! |
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| Signature | |
| Name (for program recognition) | |
| Address | |
| City | State |
| Zip | |
| Telephone (Day) | Telephone (Evening) |
| My Gift Is Eligible to Be Matched by My Employer: | |
|
(Please
enclose matching gift form.)
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