Important:
-Print this page once for each paver you wish to donate.
-Fill out the form and mail with your remittance to the address below.
-When finished printing, use your browser's "back" function to return to the previous page.
-The EmilyAnn Theatre is a 501(c)3 organization; your donation is tax-deductible.
-Thank you for sponsoring the EmilyAnn Theatre!

Yes, I want to donate a paver to the EmilyAnn Theatre!

Name:_________________________________________

Address:_______________________________________

Phone Number:_________________________________

E-mail:_______________________________________

Put on your mailing list_____     Put me on your e-mail mailing list______

I am donating the following paver (circle one choice):

A.  4X8, up to 3 lines with 12 characters per line.           ($50.00)

B.  6X12, up to 4 lines with 20 characters per line.         ($200.00)

C.  16X16, up to 10 lines with 20 characters per line.    ($500.00, graphics available at extra cost.)

Put the following inscription on my donation paver:

Line 1:     __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __

Line 2:    __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __

Line 3:    __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __

Line 4:    __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __

Total enclosed:_____________________

Please make checks payable to the EmilyAnn Theatre
Please return this form and remittance to:

the EmilyAnn Theatre
P.O. Box 801
Wimberley, Tx 78676