Charlotte Symphony Orchestra

Please fill out the form below. When you are finished, you can either click on the submit button to send it to us, or you may print out the form and mail it along with your donation to:

Charlotte Symphony
Two Wells Fargo Center
301 South Tryon Street
Charlotte, NC 28282

Please provide the following contact information:

Name:

As you wish to be listed in the program book

Address:

City:

State:

Zip Code:

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Home Phone:

E-mail:

Membership Categories

Platinum Podium $25,000+	Gold Baton $12,000-$24,999
Conductor’s Circle $6,000-$11,999	Founder $3,500-$5,999
League Benefactor $2,000-$3,499	Patron $1,250-$1,999
Affiliate Member $750-$1,249	Sustaining Member $500-$749
Contributing Member $250-$499	Friend $1-$249

I/We pledge:

Please charge my credit card:

Credit Card
Cardholder Name
Card Number
Expiration Date
Please send me an invoice to the address listed above

My employer, , will match my gift. I will mail you a matching gift form.

	I do not wish to receive any benefits which reduce the tax-deductible value of my gift.
	I want to designate my gift to the Oratorio Singers of Charlotte.
	I want to designate my gift to Education Programs.
	I want to designate my gift to Charlotte Symphony Youth Orchestras.
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