Membership Form 2007

YES!  I/We want to support the Academy of Performing Arts and receive many exciting benefits.

Print your name below as you wish it to appear in the Theatrebill.  Check here if you wish not to be listed._____

Name:_________________________________________________

Street:__________________________________

P.O. Box:_____________________________

Town/City: ______________________________

State :_________________ Zip:____________

Daytime phone: (______) _______________

Evening phone: (______) _____________

___Student      $25                                         

___Star            $125 - $249

___Individual   $45 - $74                                

___Director      $250 - $499

___Family        $75 - $124                              

___Producer    $500 - $999

____Angel       $1000+

___My Company has a Matching Gift Program. 
Enclosed is my Matching Gift Form.

___Enclosed is my check for $________

Please charge my:  ___Master Card  ___Visa

Credit Card #__________________ 

Cardholder’s Name _______________________

Expiration Date:_________________ 

Signature:__________________________________

Please send this form with your check made payable to

Academy of Performing Arts, P.O. Box 1843, Orleans, MA 02653

We thank you for your support and welcome
you to the Academy Family