Dancers Circle 25 26

Dancers' Circle Participation Level
Champion ($5,000)Aficionado ($2,500)Devotee ($1,500)Enthusiast ($1,000)Patron ($750)Supporter ($500)Friend ($250)Other
Note: To complete your donation over multilple payments, contact lynngillen@me.com. Check donations are accepted at the Front Desk without completing this form.
Please type in your preference for donor recognition:
Examples: The Smith Family; Mr. and Mrs. Smith; Mary and John Smith
Comment / Note:
Contact Information
Do you have a dancer who is a member of RDT?

YesNo
Dancer's Name(s):
Name*
Phone Number*

Area CodePhone Number
Email*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Total Donation Amount from your selection above:*

USDAmount to be Charged to Credit Card