I/we wish to donate a TOTAL of:

   □  $25,000  ($5,000/year for 5 years)

   □  $15,000  ($3,000/year for 5 years)

   □  $10,000  ($2,000/year for 5 years)

   □    $5,000  ($1,000/year for 5 years)

   □    $2,500     ($500/year for 5 years)

   □    $1,000     ($200/year for 5 years)

   □       $500     ($100/year for 5 years)

   □       $250       ($50/year for 5 years)

   □       $150 per seat for ______ seats

     (to be shown on Seat Donors Chart)

   □   $ _________________________

   and I/we wish to pay this:

   □  in one payment now

   □  in one payment on ____________

   □  per the payment schedule shown on the left

   □  $ _________ now, then $_________

         each year for ______ years

   □  other:  ___________________________

         ________________________________

     (minimum annual payments of $50, please)

     THANK YOU FOR YOUR GIFT!

Donors of $150 or more will be shown by level on  

  the  Murray Centennial Wall of Honor

                        in the theater lobby

  □    Please identify this gift in the

           ___ honor   ___ memory    of:

 □  Please charge my __ MC  __ Visa for $ _____

 Number: ____________________ Exp: _______

           Please enclose this sheet with your donation and mail to:

                                    Richmond Civic Theatre

                                    attention: Centennial Campaign                         

                                    1003 E. Main St.     

                                    Richmond, Indiana  47374