Print this page and send it to us along with your donation check!
YES! I support the New Chamber Ballet with a contribution at the following level:

(  ) QUINTET ($200 to $499)
(  ) QUARTET ($500 to $999)
(  ) TRIO ($1,000 to $2,499)
(  ) DUET ($2,500 to $4,999)
(  ) SOLO ($5,000+)
( ) OTHER __________

IMPORTANT: Please make checks payable to New Chamber Ballet, Inc and mail the check to:

New Chamber Ballet
250 West 103rd Street, #7B
New York, NY 10025

Name: _________________________________
( ) check here if you would like your gift to be anonymous.
Mailing Address: ___________________________________
City, State, ZIP: ____________________________________
Phone: ____________________________________
e-mail: ____________________________________

A MATCHING GIFT from your company can bring you to a higher benefit level.
( ) My company has a matching gift program. The form is enclosed.

( ) I do not wish to receive any benefits which would decrease the tax deductibility of this gift.

( ) I wish for my gift to be used exclusively for the Dancers Fund.