Name
Friend of the Arts $100
Phone
Supporter of the Arts $250
Address
Patron of the Arts $500
Gift: Choice of CD from ACSWI Gallery Shop*
Gift: Pottery by Lisa Heichelbech*
Gift: Choice of Evansville print by Nikki Pritchett*
City
State
Email Address
Zip Code
Electronic correspondence saves on postage
and helps your donation dollars better further our mission.
Check
Cash
Card
Arts Leader $1000
Gift: Pottery by Les Miley*
Other $ __________
*ACSWI will contact you upon receiving your
donation to confirm your choice of gift.
Name on card
Card Number
Expiration Date
One time payment
I would like to pay monthly and give permission for ACSWI to charge $_______ to my card on the 1st of each month for 12 months.
318 Main St. Ste. 101 | Evansville, IN 47708 | 812.422.2111 | [email protected]