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CHEVALIER THEATRE DONATION FORM

(Print out this page, tear off this form and mail it to: Chevalier Theatre, P.O. Box 817, Medford, MA 02155. Thank you!)

YES, I would like to help restore the Chevalier Theatre:

_____ Enclosed is my check in the amount of $__________________________________

_____ I would like to volunteer in the area of____________________________________

_____ I would like to donate (items)__________________________________________

_____ I would like to donate $______________________________ for restoration or installaton of the organ(s).

_____ I would like to talk/learn more. Please call me.
                         

Name:

Street Address:                                                     City:                     State:                 Zip:     
Phone (please include area code):                                                     E-Mail::


Donations make a wonderful honorarium or memorial gift. If you wish your donation to be an honorarium or memorial, please fill out information below.

This donation is given in honor/memory of:

 

Please use the rest of this page and the back for any comments/suggestions. We THANK YOU for your support!