Sponsorship Contribution

Amount ___________________ Date ___________

NAME AND ADDRESS: _________________________________________________

_____________________________________________________________________

PHONE ____________________________ E-MAIL ____________________________

PAYMENT METHOD Check ________ Credit Card # __________________________ (Mastercard/Visa Only) CC Expiration Date: __________________

Name on Card: ________________________

Is your primary area of interest Visual Arts _________ Literary Arts ___________

Is there someone you would recommend to receive our program listing?

_______________________________________________________________________________________

Please Print This Form and Mail to:
The Great River Arts Institute
P.O. Box 48
Bellows Falls, VT 05101

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