AMERICAN HERITAGE ON TAP fund - DONATION FORM

Concerned about providing the information that is "required" below? As stated in our privacy policy,
any and all personal information you provide is kept STRICTLY confidential and is not sold to anyone.

DONOR'S INFO

Option #1: The Buster Brown "Future of Tap Dance" Scholarship Fund 
   1A - I would like to make a general donation to help support tap dancers who are dedicated and may have a bright future but do not have the financial resources to attend such major training programs as for example the National Tap Seminar or the American Tap Dance Institute's Spirit Of Tap" Conference.

   1B - I would like to make a specific donation to help support tap dancers who are dedicated and may have a bright future but do not have the financial resources to attend such major training programs as for example the National Tap Seminar or the American Tap Dance Institute's Spirit Of Tap" Conference.

Name of event and scholarship recipient (dancer or group):



Amount donated: $

 

 Option #2: Support A Kid 
  I would like to participate in your SUPPORT A KID CAMPAIGN.

Here is my donation of $ 2 X children = $

 

 Option #3: "Adopt" A Program  
   I would like to make a donation to support a specific NTE educational program

Program name/Date/Location (if available):



Amount donated: $

 

 Option #4: Join A Club !  
I prefer to make a "standard" contribution

Please check one club only.

 

  I AM PAYING BY CREDIT CARD (sorry, we cannot process debit cards)

Please charge my:         Visa           MasterCard           Discover           American Express

card # (do not insert spaces between characters)

Cardholder's name (exactly as appearing on card)

Expiration date (please use your card's format, for example 06/03 for June 2003):  

I choose to pay

    in full

OR

    in installments of $ each to be charged on or after the following dates

  I AM PAYING BY CHECK, MONEY ORDER OR BANK DRAFT

I am printing this form and mailing it with one or more check/money order/bank draft (s)
made out to:  National Tap Ensemble

I choose to pay
    in full

OR

    in installments of $ each to be deposited on or after the following dates

Mailing address:

AHOT 
National Tap Ensemble
PO BOX 2439
Hagerstown MD 21741-2439

Notes, comments, item numbers for your complimentary products (optional)
 

Date:         Signature (use only if you mail or fax this form):______________________________

Important notes
1 - We recommend that you print and keep a copy of this form for your files, even if you pay by credit card.
2 - Did you make sure that your mailing address is complete and accurate? We will need it to send you an official letter of acknowledgment. And please make sure you entered a correct email address above as well!
3 - In accordance with Internal Revenue Service requirements, the cash value of any items you may elect to receive in return for your gift must be deducted from the amount of your tax-deductible contribution. For example, if you make a $500 contribution and ask to receive 5 posters for a total value of $95 your tax deduction will be $405. If you enter nothing in the Comments box above the full $500 may be deducted from your taxes (U.S. taxpayers only!)
4 - Problems getting this form through? Print it and fax it to: 270-964-1476.