Today's Date  

DONATION LEVEL
Please choose a level of donation.
     Archangel - $999.99
     Seraph - $500.00
     Cherub - $250.00
     Angel - $100.00
     Benefactor - $50.00
     Patron - $35.00

I would like to donate this amount for my tax deductible membership:      .

Payment Method:  I would like to pay
     in person - I will stop by the Patron Office at Eidman 107.
     by phone with a credit card (Mastercard or Visa only) - I would like someone to call me.
     by credit card - Master Card.  Name on Card:
                       This is the number:   Exp. Date:  

     by credit card - VISA.  Name on Card:
                       This is the number:   Exp. Date:  

If you paid by Credit Card online, click here to indicate that you agree to have the amount listed above to be charged to your credit card.  I AGREE. 
                               Type your name here to indicate your agreement: 
 

CONTACT INFORMATION
First Name  
Last Name   
Address        
City/State/Zip
Email             
Phone            

Name as you wish it to appear in the program:

Number of guest passes (limit 3)
(Patron Level membership only receives one guest pass)

Questions or Additional Comments?

Check here if you would like someone to call you regarding your question or comment.

Click "Submit" ONCE and print the "Form Confirmation" page that follows for your records.  You should receive your Patron Pass membership letter in 2 weeks.  If you do not receive it, please call our office at 882-7025 or send us an email at Patron@utb.edu.  Thank you for supporting the Arts in Brownsville.

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