San Pedro City Ballet - Angel of Dance Donation

Print this form, then fill in by hand and mail to:

	San Pedro City Ballet
	1231 S. Pacific Avenue
	San Pedro, CA  90731
	
When donating by credit card, You may fax this form to:
310.833.7110

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         Name:	_____________________________________________

      Address:	_____________________________________________

		_____________________________________________

		_____________________________________________

    Telephone:	_____________________________________________

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Donation amount: $________________

___ My check is enclosed.
___ Please charge my credit card.

  Credit Card:	__ Visa
		__ Master Card
		__ American Express
		__ Discover

       Amount:	_____________________________________________

     Card No.:	_____________________________________________

      Expires:	Month: _________________  Year: _____________

 Name on Card:	_____________________________________________

    Signature:	_____________________________________________


Thank you for your support!