CONTRIBUTION FORM DanceTheatre PIEDMONT Celebrating 13 years of excellence in dance! Rebecca Wiley, Artistic Director 163 West B Street Kannapolis, NC 28081 PiedmontDanceTheatre.com 704.932.8888 First Name________________________________ Last Name _______________________________ Address ___________________________________________________________________________ City ___________________________________ State _______ Zip Code ______________________ Email Address _____________________________ Phone Number ___________________________ Name/s as you wish to appear in PDT publications ________________________________________ CORPORATE GIVING I wish to contribute to PDT with a gift of $ ______________ (Please check one) PAYMENT OPTIONS Please choose one of the following payment options: ____ I would like to charge my contribution to my credit card. ____ Visa or ____ Master Card Card Number _______________________________________ Exp Date _______________ Signature __________________________________________ Today’s Date ___________ ____ Please charge the entire amount at once. ____ I wish to arrange a payment plan. Please charge my credit card: ____ Semi Annually ____ Quarterly _____ Monthly ____ I am enclosing a check payable to Piedmont Dance Theatre ____ My Company has a Matching Gift Program: ____ I am enclosing the completed form. ____ I will mail the completed form to PDT. PLEASE MAIL COMPLETED FORM TO: Piedmont Dance Theatre 163 West B Street | Kannapolis, NC 28081 ____ Production $1,000 + ____ Principal $500 + ____ Presenting $5,000 + ____ Artistic $2,500 + ____ Director’s Circle $10,000 + INDIVIDUAL GIVING I wish to contribute to PDT with a gift of $ ______________