Studio 96 CONTRIBUTION FORM

CONTRIBUTION FORM

Print and return to:
    Studio 96
    PO Box 14
    Sterling, KS 67579

I would prefer my contribution be kept confidential _______

I would prefer my name and contribution be kept confidential ______

Last Name _________________ First Name ___________________

Address ________________________

City _______________ State ____ Zip ________

Telephone: Home _______________ Work __________________

E-Mail address ____________________________________

Annual Membership Fee Schedule
Individual.............................	$ 25
Family.................................	$ 50 - $ 99
Patron.................................	$ 100 - $ 499
Benefactor..........................	$ 500 and over

Would you like to volunteer your time, resources, or ideas to Studio 96? YES !!!

STUDIO 96
Receipt of contribution

Date _________________________________

Received of ___________________________

Contribution amount ____________________

We sincerely thank you !!

location: Studio 96, Inc. 121 South Broadway Sterling, KS 67579	mailing address: Studio 96, Inc. P.O. Box 14 Sterling, KS 67579	e-mail: cynthia@studio96.org webmaster@studio96.org
copyright 2009 Studio 96, Inc. updated 08/2012