Print Off Form and Mail to 460 E.ridge Street Marquette, Mi 49855

Tear Here                                                                Method of payment: check one

Visa___ or MasterCard____

Card #________________________

Expiration Date__________________

Signature_______________________


Lake Superior Theatre, Inc.

460 East Ridge Street

Marquette, MI 49855

Name: ___________________________ Address: _________________________

________________________________

Phone: __________________________

Email:____________________________

Name: ___________________________ Address: _________________________

________________________________

Phone: __________________________

Email:____________________________

Level of giving:  Circle one$50 - $99  DECKHAND  

$100 - $149  NAVIGATOR  

$150 - $199  FIRST MATE  

$200 - $249  CAPTAIN  

$250 - or more  LIGHT KEEPER

Thank You For Your Help

____ are you interested in volunteering your time?

____ do you have a business that would consider advertising in next years program?