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Please
print this page and include with your check or service
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□ YES! I would like to contribute to the Jimmie DeFore Dance Center. Please accept
my donation or support in the amount of:
□ $50 □ $100 □ $250 □ $500 □ Other
$____
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Name:
Address:
City:
State/Zip:
Phone:
Email:
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_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
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□ Please list this gift in the following name or
manner for donor recognition _______________________________________
□ My gift is to
remain anonymous
□ Sorry, I cannot contribute at this time, please add
me to your mailing list.
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Make
checks payable to:
DeFore Foundation for the Arts
Mail to:
DeFore Dance Center
151 Kalmus Drive, Suite G3
Costa
Mesa, California 92626
Thank you for your continuing support!
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