P.O. Box 161 Newark, DE 19715-0161 Annual Fund Donation Form Yes! I want to support the continuing growth and artistic excellence of Mid-Atlantic Ballet. This donation is for: □ Benefactor: $1,000 or more □ Patron: $500 - $999 □ Partner: $250 - $499 □ Fellow: $100 - $249 □ Friend: up to $99 Amount Enclosed: $____________ Your donation is 100% tax deductible. All recipients and donors with donations of $25 or more will be listed in our 2014-2015 program books. Please complete the form below as you would like to see the names in our program books. Donation given by __________________________________________________________________ Address__________________________________________________________________________ City__________________________________________________State____________Zip_________ Email____________________________________________________________________________ Donation in honor/memory (circle one) of Thank you for your generous support! Please keep a copy of this form for your records. Mid-Atlantic Ballet’s Tax ID number is 52-2058530.100% of your donation is tax deductible.