Nicholas Andre Dance Donation Form

Amount of Gift (US$) _________

Choose one:		New Member			Renewing Member

Select a membership category:				Benefits:

Friend: $0-99 ____					Advance notice of all company events

Patron: $100-249 ____				2 invitations to post show reception
							
Benefactor: $250-499 _____		       Previous + 2 tickets to a performance of your choice

Sponsor: $500-999 ______		         Previous + 4 tickets to a performance of your choice

Guarantor: $1000-4,999 _____		         Previous + VIP seating + invitations to meet dancers

Crusader: $5,000-9,999 _____			previous along with 8 tickets to any performance

Premier Circle: $10,000 & above _____	Thanks from all of us. 

Please state how you would like to be listed in a program/website_____________________
Or I would like to be listed as an anonymous donor. _____

My employer has a matching gift program (Y/N) ______ (please send forms to our address)

What is the company name? __________________________________

*Select size of T-shirt __________(XS-L)

** Select size of long sleeve shirt ________(S-L)


If you choose to, you may specify a fund to apply your donation to by adding the name of the fund to the memo area on your check. Thank you again for your support. All donations are tax deductible to the fullest amount legally allowed by law.
Name: _________________________________________________________

Address: _______________________________________________________

City: _____________________	State: __________		Zip: ___________

Phone: ______________________	E-Mail: _________________________


Please make your gift payable to: 
Nicholas Andre Dance
PO Box 1288, New York, NY 10028