Tax-deduction Gift Amount: (Please print out this page and fax to us at 631-277-1342.)

Red Carpet: $5,000 ______

Front Row: $2,500 ______

Orchestra: $1,000 ______

Mezzanine: $500 ______

Scholarship Supporter $250 _______

Journal Ad: $100 ______

Other Amount ______

Logo or Journal ad enclosed in hardcopy
PDF or word file of logo/journal ad will be emailed to
Vickie@islipartscouncil.org

Organization/Business Name:_________________________________________________________________

Address:__________________________________________________________________________________

Town:____________________________________________________________________________________

Phone:____________________________________________________________________________________

Amex/Visa/MC/Discover # ___________________________________________ Exp: Date _______________

Thank you for your support. Make checks payable to Islip Arts Council, 50 Irish Lane, East Islip, NY 11730
Or charge by telephone during business hours at 631-224-5420