Vicksburg Theatre Guild Building Fund Donation
Federal tax identification number 64-0386859

Name:____________________________________________

Street/PO Box:______________________________________

City/State/Zip:______________________________________

Contribution

□  Platinum ($2,500 or more)

□  Gold ($1,000 to $2,499)

□  Silver ($250 to $999)

□  Bronze ($1 to $249)

□  I wish to remain anonymous.

Please make check payable to “VTG BFA Account.” and mail to:
Vicksburg Theatre Guild
P.O. Box 821472
Vicksburg, MS 39182