477 Congress Street    Portland, ME  04101    (207) 773-3150

2007–08 ANNUAL FUND CONTRIBUTION FORM

PCA Great Performances is a 501(c)(3) organization, and gifts are tax deductible as allowed by law.

Name ___________________________________________________________

Address_________________________________________________________

City_______________________________ State________  Zip_____________

Day Phone ________________________________               Evening Phone __________________________________

Your name as you wish it to appear in any public acknowledgement:________________________________________________________

Please do not acknowledge this gift in any published list of contributions.

My company will match my gift.  Enclosed is a corporate gift form.

Please call me to discuss my/our gift.

 

Gift Amount:

Great Performers Circle    $1,000 or more

Benefactor                       $500 - $999

Patron                              $250 - $499

Donor                              $100 - $249

Contributor                      $50 - $99

Other:                              $____________

 

Payment Options:

Enclosed is my check made payable to PCA Great Performances

Please charge my Mastercard/Visa

        Account # ___________________________________________    Exp. Date________________

       

       Signature__________________________________________________   Date______________     

Please call me regarding the transfer of stock or other securities.

Please contact me regarding planned giving opportunities.

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