Carolina Ballet Annual Fund Donation Form
Title
First Name
Middle Name
Last Name
Address
City
State
ZIP
Country
Phone
E-mail
Donation cannot be processed without e-mail
Will this gift be matched by your employer? Yes No
Name of employer
Please mail completed form to:
Attn: Ginny Hall
3401-131 Atlantic Avenue, Raleigh, NC 27604
I wish to receive future email correspondence Yes No
Please select your level of giving
For additional levels of giving at the Patron, Benefactor or Partner levels, please call 919.719.0800 x 234 or email Steve Bishop for additional information.
Is this a gift in Honor or Memoriam? Yes No | If yes, please specify:
Please enter the name and mailing address for the person or persons to receive gift acknowledgement.
Any other information you would like us to know:
Amount of Gift
Form of Payment MC Visa AMEX Discover
Name on Card
Credit Card Number
Expiration Date
Card ID# (3 digit # from back of credit card)

*Fields in orange are required