2014-15 Spectrum Member & Sponsor Pledge Form Name: Mailing Address: City: State: Zip: Phone: Email: Help to make a difference in our community! □ □ □ □ □ Ruby Slipper Level Sponsor $2,500 Gold Lamé Level Sponsor $1,000 Duet Membership $500 Individual Membership $300 I would like to make a gift to CSO Spectrum in honor of Peter G. Courlas with a contribution of $______ Invoice and Payment Method □ My check is attached □ Please charge my credit card: □ Visa □ MasterCard □ American Express □ Discover Card Number_____________________________________ Expiration Date_____________________ Installment option: Pledge must be paid in full by January 30, 2015 □ Please charge me for the full amount on ___________________________________________ □ Please charge me in two installments on __________________ and _________________ (dates) For Corporate friends and matching gifts: □ My company’s check is attached □ I am submitting Matching Gift forms with my company I am an authorized representative of the above-named company and give the Cincinnati Symphony Orchestra permission to use the company name andor logo in print and promotional materials. By signing this pledge form I assure that our company will honor its pledge payment by the terms indicated. Signature: Date: Print Name and Title: Return to M. Todd Bezold, Director of Marketing, Subscriptions Cincinnati Symphony Orchestra ● 1241 Elm Street ● Cincinnati, OH 45202 Email: [email protected] ● Phone: 513-744-3320
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