Patron/Benefactor Registration Form

Logan Circle Community Association

32nd ANNUAL HOLIDAY HOUSE TOUR

SUNDAY, DECEMBER 5, 2010

Patron and Benefactor Registration Form

INDIVIDUAL PATRONS/INDIVIDUAL BENEFACTORS

Individual Patrons contribute $50.00 and receive one ticket to the Tour

Individual Benefactors contribute $100.00 and receive two tickets to the Tour

BUSINESS PATRONS/BUSINESS BENEFACTORS

Business Patrons contribute $150.00 and receive two tickets to the Tour

Business Benefactors contribute $200.00 and receive four tickets to the Tour

Patrons and Benefactors are acknowledged in the LCCA House Tour program.

_____ I wish to be an Individual Patron ($50)

_____ I wish to be an Individual Benefactor ($100)

_____ I wish to be a Business Patron ($150)

_____ I wish to be a Business Benefactor ($200)

Name/Business Name: ______________________________________________

Address: __________________________________________________________

City: ________________________ State: _________ Zip Code: _____________

Telephone: ________________________ Email: _________________________

How do you wish to be listed in the program?___________________________

PLEASE MAKE CHECK PAYABLE TO LCCA HOUSE TOUR AND RETURN TO:

Tim Christensen, 1320 13th Street, N.W. #13, Washington, DC 20005; phone (202) 641-6934, e-mail tim.christensen@logancircle.org. Checks must be received by COB Monday, November 15, 2010 for your name to be included in the program.

OR

CHARGE MY DONATION to my _____ Visa _____MC

_______________________________________ _______________

CARD NUMBER EXPIRATION DATE

_______________________________________

SIGNATURE

THANK YOU FOR YOUR SUPPORT

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