Donor Form
FRIENDS OF
ZOELLNER
ARTS
CENTER
DONOR FORM (2008-2009 Season)
NAME(S) ________________________________________________
Please print your name(s) as you wish it (them) to appear in the program.
ADDRESS _______________________________________________
CITY __________________________________ STATE____________
ZIP ____________ DAY PHONE _____________________________
EVENING_____________ EMAIL _____________________________
DONOR OPTIONS (Please circle one.)
CHARITABLE PORTION OF GIFT PLUS FEES:
Donation
Charitable
Fees
LU Fac/Staff Fees LU F/S Charitable
Friend
$100
$100
N/A
N/A
Patron
$250
$250
N/A
N/A
Fellow
$500
$425
$75
$225
$275
Artist
$1000
$915
$85
$385
$615
Maestro
$2500
$2275
$225
$525
$1,975
Producer
$5000
$4745
$255
$555
$4,445
CHARITABLE BENEFITS:
I/we choose not to receive any donor benefits beyond program listing.
(The entire contribution may then be considered tax-deductible.)
PAYMENT OPTIONS (Please check one)
Enclosed is a check, payable to
Lehigh
University
, for $_____________________
Please charge my credit card for $ _____________________________________
Circle one: MasterCard VISA American Express
Card number ______________________________Expiration Date _______
Name on card ____________________________________________________________
Signature ____________________________________________________________
Please bill me for a pledge of $_________________________________
Gift of stock: Please call the Arts Development Office at 610-758-3129.
Matching Gift: My/My spouse's company will match my gift to the extent of
$ _______________________. (The appropriate matching gift form is enclosed.)
Payroll Deduction (For Lehigh University employees only : Download and print the “Payroll Deduction Form for Charitable Contributions.”
Fax or mail completed form to:
Zoellner Arts Center Development
27 Memorial Drive West
Bethlehem , PA 18015-3086
Tel: 610-758-3129
Fax: 610-758-5949
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