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Donation Form

YES, I/we would like to support the Conservancy's efforts to save and revive the Takoma Theatre
Please complete, print and mail form below with your check to:

Takoma Theatre Conservancy
P.O. Box 55288
Washington, D.C. 20040

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$50 Member
$100 Friend
$200 Founder*
$500 Sponsor*
$1,000+ Patron*
$5,000+ Benefactor
Other*
Contribution (Membership is per household):
$
*Please do not list my(our) name(s) on Conservancy website as major donor(s)
Do not add my(our) name(s) to low volume discussion list about Conservancy activities
Contributors
1. First Name*
Last Name*
2. First Name
Last Name
(* = required entry)
Address1: *
Phone(h):
Address2:
City: *
State: *
Zip: *
E-mail: *
Yes, I/we
would like
to help with:
(w)
(c)
Programming & Marketing
Finances & Fundraising
Facilities Acquisition & Development
Public Relations
Website
Other

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