Donor’s Name __________________________________________________
Donor’s Business Name __________________________________________
Address _______________________________________________________
City / State / Zip __________________________________________________
Phone ______________________________ Cell _______________________
E-mail _________________________________________________________
___ I am giving more than $200 and would like a family membershipMethod of Payment: __ Check __ Visa __ MasterCard __ Discover
Card # _____________________________________ Exp. Date ____________
Signature __________________________________ Date _________________
South Haven Center for the Arts / 600 Phoenix St. / South Haven, MI 49090



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