PLEASE USE THIS FORM TO PURCHASE TICKETS.


Thank you for your generous contribution supporting our Fellowship Program for emerging artists and writers.


 

First Name  

Last Name  

email  

Address  

City  

State Zip
Telephone  


$125 Ticket:



Quantity    



$500 PATRON: 2 Tickets • Signed copy of Forbidden City by Gail Mazur • Listing in evening program



Quantity    



$1,000 BENEFACTOR: 2 Tickets & 2 Dinners at TROY Boston • Signed copy of Forbidden City by Gail Mazur
• Listing in evening program



Quantity    



$2,500 GOLD BENEFACTOR: 4 Tickets & 4 Dinners at TROY Boston • Signed copy of Forbidden City by Gail Mazur • Sponsorship of 6 Fellows to attend the event
• Listing in evening program



Quantity    



I am unable to attend but I would like to
make a contribution of

 I am a current FAWC member at the $250 Supporting Level or above. Please apply 10% discount.



TOTAL   $ 


Cardholder name: Card #


Exp.date    Card Verification Number* 

*For your safety and security, we require that you enter your card's verification number. This is 3 or 4 digit number printed on the back of your card.

Comments: (also, please list your name as you would like it to appear in the evening program and the name(s) of your guests.)

 

Thank you for joining us at this upcoming event.





 
©2017 FINE ARTS WORK CENTER · 24 Pearl Street · Provincetown, MA 02657 · phone: 508.487.9960
boston