Please take a moment to consider the level of support that
is right for you.
_____ Artistic Director's Circle ($1001 - $2000)
_____ Principal ($500 - $1000)
_____ Soloist ($250 - $499)
_____ Corps de Ballet (to $249)
Other $________
I am/We are making this tax deductible gift
in memory of ____________________________________________
or
in honor of ______________________________________________
Name: ______________________________________________________________________
Address: _____________________________________________________________________
City/State/Zip: _________________________________________________________________
Phone: Day ______________________________ Evening ______________________________
E-Mail: _______________________________________________________________________
_____ Check Payable to Allegheny Ballet Company
_____ Mastercard _____ Visa
Account #: _________________________________________ Expiration Date ______________
Amount Enclosed $_________________________
Employer's Matching Gift Enclosed $ ________________________
Solicited By: ___________________________________________________________________
Please Mail Your Completed Form And Contribution To:
Allegheny Ballet Company
PO Box 369
Altoona, PA 16603