MOUNDS THEATRE Donation Form

YES! I AM EXCITED BY WHAT IS HAPPENING AT THE MOUNDS THEATRE, AND WOULD LIKE TO BECOME A SPONSOR.
Here is my financial contribution to the success of the Mounds Thatre Company and the Performing Arts Youth Conservatory:

First Name ________________________  Last Name __________________________

Organization ____________________________________________________________

Address _________________________________________________________________

City _______________________________  State _____  Zip Code _____________

Email ______________________________  Phone number ______________________

____ $20    ____ $50    ____ $250    ____ $500 (FOUNDER)    Other $______
*Contributions of $100 or more will receive recognition in season programs

_____ Check Enclosed  (Make checks payable to: Mounds Theatre)

_____ Charge my VISA      _____ Charge my MASTERCARD

_____ Charge my AMEX      _____ Charge my DISCOVER

Credit Card #: _________________________________  Exp. Date: ____________

Signature: _____________________________________

PLEASE SEND PAYMENTS TO:
The Mounds Theatre
1029 Hudson Road
St. Paul, MN 55106