Earlville Opera House Membership/Contribution Form
Membership Levels
$40 Basic
$100 Contributing
$250 Supporting
$500 Patron
$1000 Benefactor
Please circle your level of support above.
Seniors over 65 may deduct 20% here $_______
Final senior membership level of support $_______
Other support opportunities:
Scholarships Fund $_______
Capital Campaign $_______
General Donation $_______
Total: $________________________________
____ Check ___ VISA ___ Master Card
Credit Card #: _____________________________
Expiration Date: ___________________________
Name: ___________________________________
Address: _________________________________
Phone/Email: ______________________________
___ Please keep this gift anonymous
___ Please contact me about planned giving
___ Please contact me about volunteering
Please mail to: Earlville Opera House
Box 111, Earlville New York 13332
Phone 315-691-3550