Yes, I wish to be a part of the theater in the following way(s):
Yes, I wish to be a part of the theater in the following way(s):
____
A Theater Seat @ $1,000 each___8
" x 8" Brick @ $250 each
___4
" x 8" Brick @ $100 each
Your name
_________________________________Street
_____________________________________City
_________________ State/Zip _____________Phone
_________________ Ema i l ___________________________Message to be engraved on SEAT: (3 lines)
Line 1 _________________________________
Line 2 _________________________________
Line 3 _________________________________
Message to be engraved on BRICK:
4
" x 8" bricks - 3 lines of 14 characters, inc. spaces8
" x 8" bricks - 6 lines of 14 characters, inc. spacesLine 1 _________________________________
Line 2 _________________________________
Line 3 _________________________________
Line 4 _________________________________
Line 5 _________________________________
Line 6 _________________________________
Please select payment method:
$______Check enclosed $_____Credit Card
Visa or Mastercard
____________________________________________Name as it appears on the card
_________________________________________________
Account # Exp. Date
Please mail this form and check to:
Charles R. Wood Theater
207 Glen St
Glens Falls, NY 12801
The Charles R Wood Theater is a 501(c)3 organization and this contribution is deductible to the fullest extent of the law.