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
Friend...............................	30.00 - 99.00
Patron...............................	100.00 - 499.00
Sponsor............................	500.00 - 999.00
Benefactor........................	1000.00 +

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 North 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 3/2009