Phone : ____________________________________________________ Company : _________________________________________________ City : _______________________________________ Prov : _____________________ Postal Code : ______________________ Email : __________________________________________
SELECT YOUR PREFERRED DONOR LEVEL ROSE GIVING Supporter $1-149
Affiliate $1000-2499
Member $150-499
Dress Circle $2500+
Friend $500-999
Other amount $ ___________________
METHOD OF PAYMENT (SELECT PAYMENT METHOD BELOW) Amount : $ _______________________________________ Cheque Cheque # ______________________________ Credit Card
Visa
MC
Amex
Card No : ___________________________________ Card Name : ________________________________ Exp. : ____________/_____________/____________ Signature : __________________________________ I hereby authorize the Corporation of the City of Brampton to charge the
SUPPORT THE ROSE
Address : __________________________________________________
BECOME A DONOR
Name : ____________________________________________________
Please use the following name(s) in all acknowledgements: _____________________________________________________________________________________________________________ I (we) wish to have our gift remain anonymous
I (we) wish to receive emails about upcoming shows and promotions at The Rose
Donor Signature : ______________________________________ Date : ________________________________________ Staff Signature : _______________________________________ Date : ________________________________________
Personal information is being collected under the authority of the Municipal Act for the purpose of sending email newsletters and processing payments. Questions about this collection may be directed to the Rose, 2 Wellington St. W., Brampton, ON, L6Y 4R2, 905.793.8490.
DONOR SERVICES TheRoseBrampton.ca
EMAIL : abigail.taylor@brampton.ca CONTACT : 905.874.3956 ADDRESS : 2 WELLINGTON ST. W, BRAMPTON, ON L6Y 4R2
Photo: Krish Khasnobish, Centre Stage 2019
Donations of $20 or more include a charitable tax receipt. Your tax receipt will be a little less than your total donation. Governments require that we
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ACKNOWLEDGEMENT INFORMATION: