marin dance theatre
Artistic Director – Margaret Swarthout

DONATION FORM

CONTACT INFORMATION:

Name______________________________________

Address_______________________________________________________________________

City___________________________________   State_______   Zip Code_________________

Home Tel:________________________   Cell:__________________________

E-Mail:________________________

I would like to make my contribution in honor of:

Name:_______________________________________________

Address: _____________________________________________                

PAYMENT INFORMATION:

Donation Suggestions
   Scholarship Fund
  
Outreach Fund
   Scholarship Fund
  
Endowment Fund
   Capital Campaign Fund
  
General Operating Fund
   Spirit of MDT Award
  
Costume Fund

Amount Enclosed  $____________________

Check No.___________________________

Credit Card No. ____________________________________Exp. Date:______________

Billing Zip Code: ____________________
 

Signature_______________________________________________________________
 

Donations are tax deductable.

Thank you for supporting MDT!

Please mail or fax this form to:
Marin Dance Theatre, One St. Vincent Drive, San Rafael, CA 94903

Tel: (415) 499-8891  ·  Fax: (415) 499-7687  ·  Email: infor@mdt.org
Marin Dance Theatre is a 501(c)3 Non profit organization, Taxpayer ID #  68-0392279

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