Concert Series Online Membership Form
Thank you for choosing to become a member of the Greater Hazleton Concert Series and support the arts in Hazleton!

Please fill out the following form as thoroughly as possible. Not all fields are required to submit the form, but we appreciate you taking the time to fill it out accurately.

(Remember, membership is NOT required to attend any of our concerts; you may purchase tickets for individual events without becoming a member or donating.)

Name:
Address:
City:
State:
Zip:
Email:
I am being enrolled by: (if applicable, enter name of worker, newspaper, other)
Number of memberships:
Adults @ $80 Students and college
with ID @ $40 		Family @ $180
(2 adults and their
children 18 and under)
Contributions:
Tax-deductible
Musician's Circle Contribution		 $ Musician's Circle Classifications
$10-24 Orchestra
$25-49 Concert Master
$50-99 Conductor
$100-249 Music Director
Tax-deductible
Underwriter Contribution		 $ Underwriters Classifications
$250-499 Patron (1/3 page ad)
$500-999 Benefactor (1/2 page ad)
$1,000-1,999 Contributor (Full page ad)
$2,000-5,000 Sponsor (Full page ad and choice of location)
Payment:
Please enter
Total Payment Due 		$    
In order for names to appear in programs, contributions must be received by August 15.

PAYMENT CANNOT BE MADE ONLINE AT THIS TIME.
After you submit the order below, please mail your payment to:
Greater Hazleton Concert Series, Inc.
P.O. Box 2781
Hazleton, PA 18201

If you wish to pay by VISA or MC, please call us at 570-788-1985.

 (Be sure to press submit to transmit your information to us!)

Website contents Copyright © 2006-2011 Greater Hazleton Concert Series, Inc. All rights reserved.
Greater Hazleton Concert Series, Inc., P.O. Box 2781, Hazleton, PA 18201
Phone: 570-788-4864
Email: info@hazletonconcertseries.org

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