Pledge Form - Cincinnati Symphony and Pops Orchestra

2014-15 Spectrum Member & Sponsor Pledge Form
Mailing Address:
Help to make a difference in our community!
Ruby Slipper Level Sponsor
Gold Lamé Level Sponsor
Duet Membership
Individual Membership
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.
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