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Membership Information

Please fill out the following form, then print out and mail with your payment.

YES! I will attend and support Theater Bartlesville

Date:
Annual Memberships are $21 per person. Members are entitled to $5 off the regular ticket prices. Membership dues are tax deductible.

A. Number of. memberships x $21 =
B. My Tax Deductible Contribution:
Sponsor $45-60, Patron $61-115
Benefactor $116-305, Sustainer $305 & over

C. TOTAL (Make checks payable to read Theater Bartlesville, 312 S. Dewey, Bartlesville, OK 74003)
A.


B.

C.

Name:
(as I want it to appear on each program)

Street:
City: State: Zip:
Home Phone: Business Phone:
E-mail:

Member1 Birthday:

Member2 Birthday:

 

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