Patron Form

Yes, I would like to be a Bloomfield Players Patron!

My donation is $

(Checks payable to Bloomfield Players)

Gift made in memory of:

or in honor of:

May we acknowledge your gift (amount omitted) in our:
Program? Website?

Patron Levels:
$25 — Fan	$26-50 — Understudy
$51-75 — Spotlight	$76-100 — Headline
$101-150 — Silver	$151-200 — Gold
$201-500 — Benefactor	$501 & up — Star

Mail check to:
Bloomfield Players
P.O. Box 7174
Bloomfield Hills, MI 48302

First name

Last name

Address

City

State

Zip code

Telephone

E-mail

(Please read our Privacy Notice before submitting this form)

Bloomfield Players Community Theatre is a public charity under section 501(c)(3) of the Internal Revenue Code, eligible to receive tax-deductible donations under section 170 of the Code. Verification of status is available at http://www.irs.gov/Charities-&-Non-Profits/Exempt-Organizations->Select-Check. (Search for "Bloomfield Players" using quotation marks.) Consult your tax advisor for the effect on your personal tax situation. You will be sent written acknowledgement of your donation, which will state the amount of your donation less the value of the complimentary tickets to which you are entitled. If you notify us that you wish to decline the complimentary tickets, the letter will indicate the total amount of the donation. E-mail with any questions.