Name: _____________________________________________________________
Address1: ________________________________________________________
Address2: ________________________________________________________
City: ________________________________________________________
State: __________________________________________________________
Zip: ___________________________________________________________
Email: ___________________________________________________________
Sign me up! I'm excited to be part of this effort to redevelop the Colonial Theater, A New Hampshire Historic Landmark built in 1915, into a modern, multi-purpose center for film and the performing arts.
Sign me up for:
________ individual memberships at $35 each
________ family membership at $70 includes everyone in your household
Please list names for Individual Membership cards:
________________________________
________________________________
________________________________
(Use reverse side for extra names)
I would like to make an additional tax-deductible gift in the amount of $________ .
Payment information
Credit Card number: ___________________________________ Exp. Date: __________________
If your Billing Address differs from that above, please enter on reverse side of this form.
Mail completed application with your check, VISA or MasterCard to:
Colonial Theatre
PO Box 204
Bethlehem, NH 03574
*Note: The Friends of the Colonial operates under the auspices of the Bethlehem Redevelopment Association. As such, your donation is tax deductible.
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