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