To make a donation by mail, print this form, complete the information, and mail to the address shown below.  
 

 

Patron's Fund

I would like to support the Lakes Region Symphony Orchestra with my tax-deductible contribution of:

 $1000
 $500
 $250
 $100
 $75
 $50
 $25
 $_________ other

Conductor's Circle: $1000+
Grand Benefactor: $500 - $999
Benefactor: $250 - $499
Patron: $100 - $249
Donor: $50 - $99
Friend: $25 - $49

 
   
 
Name:
 
Address:
 
City, State, Zip:
 
Telephone:
 
Email:
 
Name as it should appear in the program:
 
Donations must be received by 10/1/16 to be printed in the season-long program book.
 
 

Please enclose a check and return to:           

Lakes Region Symphony Orchestra
P.O. Box 721
Meredith, NH 03253

You will receive a receipt for your tax-deductible donation. THANK YOU!