Lansdowne Symphony Orchestra Subscription and Contribution Form

Please fill in the following form and print it:

Name

Address

City, State, Zip

Phone Number

Email Address

Five-Ticket Adult Subscriptions @ $50.00 each

Five-Ticket Senior Subscriptions @ $40.00 each

Family Plan Subscriptions @ $100.00 each

Champion $500 or more $

Patron $250 to $499 $

Benefactor $100 to $249 $

Sponsor $50 to $99 $

Contributor $25 to $49 $

Friend $10 to $24 $

Total Amount Enclosed $

Please send completed form and
check made payable to Lansdowne Symphony Orchestra to:

Lansdowne Symphony Orchestra
28 North Lansdowne Avenue, Suite 1
PO Box 184
Lansdowne, PA 19050-0184

	Five-Ticket Adult Subscriptions @	$50.00 each
	Five-Ticket Senior Subscriptions @	$40.00 each
	Family Plan Subscriptions @	$100.00 each

Champion	$500 or more	$
Patron	$250 to $499	$
Benefactor	$100 to $249	$
Sponsor	$50 to $99	$
Contributor	$25 to $49	$
Friend	$10 to $24	$
Total Amount Enclosed		$