piedmont 163 west b street kannapolis, nc 28081...
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CONTRIBUTION FORM
DanceTheatre PIEDMONT Ce lebrating 13 years of excell ence in dance! Rebecca Wiley, Artistic Director
163 West B Street Kannapolis, NC 28081 PiedmontDanceTheatre.com 704.932.8888
First Name________________________________ Last Name _______________________________
Address ___________________________________________________________________________
City ___________________________________ State _______ Zip Code ______________________
Email Address _____________________________ Phone Number ___________________________
Name/s as you wish to appear in PDT publications ________________________________________
CORPORATE GIVING I wish to contribute to PDT with a gift of $ ______________ (Please check one)
PAYMENT OPTIONS Please choose one of the following payment options: ____ I would like to charge my contribution to my credit card.
____ Visa or ____ Master Card Card Number _______________________________________ Exp Date _______________ Signature __________________________________________ Today’s Date ___________
____ Please charge the entire amount at once. ____ I wish to arrange a payment plan. Please charge my credit card: ____ Semi Annually ____ Quarterly _____ Monthly ____ I am enclosing a check payable to Piedmont Dance Theatre ____ My Company has a Matching Gift Program: ____ I am enclosing the completed form. ____ I will mail the completed form to PDT.
PLEASE MAIL COMPLETED FORM TO: Piedmont Dance Theatre
163 West B Street | Kannapolis, NC 28081
____ Production $1,000 + ____ Principal $500 +
____ Presenting $5,000 + ____ Artistic $2,500 +
____ Director’s Circle $10,000 +
INDIVIDUAL GIVING I wish to contribute to PDT with a gift of $ ______________