Name (Please Print)
_________________________________________
Address
_________________________________________________
City, State __________________________________
Zip_________
Phone _____________________
____a.$250 Performer
____b.$200 Patron
____
c.$150 Underwriter
____ d.$100 Producer/Business
____ e.$50
Director/Couple
____f.$25 Associate
Director
I’ve
enclosed an additional $________ for the Farris Foundation
Payment:
____
Check
____
MasterCard/Visa
Card
#________________________________ Exp. _________
Please
print and mail this card along with your check made payable to:
Friends of the Farris
301 West Main
Richmond,
MO 64085
Your membership and contributions may be tax deductible, please consult your tax advisor.