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Fremont Civic Theatre

P.O. Box 1233 - Cañon City, CO 81215-1233

e-mail: info@fremontcivictheatre.org --Website: www.fremontcivictheatre.org

Date Paid: ________________ Amount Paid: ______________

Membership Level: ___________________________________

Yes, I want to join with Fremont Civic Theatre in fostering growth in community theater. Enclosed is my tax deductible contribution:

$10

"Understudy" - Student Membership (enrolled at any school)

$15

"Star" - Individual Membership

$24

"Cast" - Family Membership (2 adults and children under 18)

$50+

"Director"

$150

Friend of the Theatre

$250

Mezzanine Sponsor

$500

Front Row Sponsor

$750

Center Stage Sponsor

$1,000

Performance Sponsor

$1,500

Educational Grant

$2,500

Challenge Grant

$5,000

Exucutive Challenge

$10,000

Season Sponsor

Additional Donation

__ Please put my additional donation towards the FCT home fund

Total Enclosed: _________

Name: _________________________________________________________________________

Address: ________________________________________________________________________

City, State, Zip: ___________________________________________________________________

E-mail address: ___________________________________________________________________

Telephone (Home): __________________________

Work: ________________________________

I would like to become involved with Fremont Civic Theatre. I am interested in (please check as many as you like):

__ Acting

__ Lighting

__ Publicity

__ Makeup

__ Directing

__ Sound

__ Newsletter

__ Props

__ Play Selection

__ Set Construction

__ Fund Raising Activities

__ Costumes

__ Set Design

__ Other _____________________________________________________

__ Please Contact Me