Name: _________________________________________________________________
Address: ________________________________________________________________
City/Town ______________ State _____________ Zip ___________
Membership Categories:
Benefactor: Over $1000
Donor: $100 - $249
Patron: $500 - 999 Friend: $50 - $99
Sponsor: $250 - $499
Contributor: $25 - $49
Amount of Donation: $ __________________
Please include me on your mailing list:
Yes/No
How did you hear about the Loudoun Chorale?
___________________________________
Please make checks payable to Loudoun Chorale.
THANK YOU for your support!
The
Loudoun Chorale
PO
Box 6197
Leesburg, Virginia 20178
(703) 722-3826