STOP THE LEAK!

TOWN HALL 2010 FUNDRAISER DONATION FORM

YES, I would like to contribute to the Future of Town Hall and of our Community,
and end the Town Hall Flood once and for all.

Return this form to:

Town Hall Theatre, 3535 School Street, Lafayette, CA 94549 Attention: Donation.
Questions? Please call (925) 283 6673.

Your Name:

Street Address:

City, State, ZIP Code:

Telephone:

Email Address:

I would like to contribute ____ x $100.00 = $__________ to the future of Town Hall.

For each $100 we will place a tag on the wall at the theatre. Please fill in what you would like:
Your Name, in Honor of, in Memory of, or Anonymous:

Payment Made by: _____Check (to Town Hall Theatre) _____Visa _____MasterCard

Card Number:

Expiration (mm/yy): /

Name on Card:

Does your company match your charitable contributions? Yes No

TOWN HALL THEATRE STOP THE LEAK: DONOR RECEIPT (KEEP FOR YOUR RECORDS)
Town Hall Theatre is a 501(c)(3) nonprofit and your donation is tax-deductible to the extent allowed by law,
Tax ID # 94-6124107.

DATE AMOUNT CHECK #

THANK YOU
On behalf of the future casts, crews, staff, patrons and students at Your Town Hall Theatre.