Name: _____________________________________________________________
Street Address: ________________________________________________________
Billing Address: ________________________________________________________
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 _____ household members
Gift Recipient ___________________________________
Address ___________________________________
City ___________________________________
State/Zip ___________________________________
Daytime Phone (_____) ___________________________________
Email ___________________________________
I would like to make an additional tax-deductible gift in the amount of $________ .
Payment information
Enclosed is my ___Check ____Visa ____MasterCard ____Discover
Credit Card number: _______________________________ Exp. Date: ______/______
Mail completed application with your payment 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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