Donor Contribution Form - Lakes Region Symphony Orchestra, Meredith, New Hampshire

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:

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

	Name:
	Address:
	City, State, Zip:
	Telephone:
	Email:
	Name as it should appear in the program:

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!