Monumental
Sponsor
(500+)

Fabulous
Partner
(100-499)

Wonderful
Supporter
(10-99)

 Enclosed $ _________

(Please make check Payable to Dancers, Inc.)

Would you like your name to appear on the donor list?
Yes            No

Name _____________________________________________

Address _____________________________________________

Phone ___________________________(H) Phone_________________________  (W)(C)

We will send you a receipt and put you on our mailing list.