Please note: Membership begins when this donation form is received and continues through June 30th.

Your name:

Spouse's Name: (if joint membership)

Street Address:
City/State: Zip:

Daytime Phone:
Evening Phone:

Membership Levels	Amount of Donation
Archangel: $2,000 +
Angel: $1,000 -$1,999
Producer: $500 - $999
Director: $250 - $499
Leading Player: $125 - $249
Supporting Player: $60 - $124
Chorus and Crew: $30 - $59

Please print your name(s) as you wish them to appear in the programs.

___________________________________________________________

I wish to remain anonymous.
Check enclosed (payable to the University Theatre Guild
Please charge my VISA | MASTERCARD | DISCOVER
Card Number:
Expiration Date:

Signature: ___________________________________________________

Please send matching gift form if you or your spouse work for a participating firm.