LCT Patron Program

Donation Information
Amount:	Associate Patron $ 1,000.00 Patron $ 2,500.00 Supporting Patron $ 5,000.00 Sponsor Patron $ 7,500.00 Benefactor Patron $ 10,000.00 Playwright's Circle $ 15,000.00 Producer's Circle $ 25,000.00 Other $     *
Additional Information
Type of gift:	One-time gift Pledge (installments):
Frequency:	Weekly Monthly Quarterly Annually On:   Sunday Monday Tuesday Wednesday Thursday Friday Saturday Starting:    Ending:   Ending:
Anonymous:	I prefer to make this donation anonymously
Playbill Listing or Comments:
New Patrons: How did you hear about our program?	Ad in Playbill Email from LCT LCT Website Other (Please specify in comment box)
Billing Information
Title:	<Please select> Dr. Honorable Mr. Mrs. Ms. Rabbi Reverend	*
First name:		*
Last name:		*
Country:	United States	*
Address lines:		*
City:		*
State:	<Please Select> AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY AE AA AP AB AS BC CZ FM GU MB MH MP NB NT NS NL NU ON PE PR PW QC SK VI YT NSW Swe Yes	*
ZIP:		*
Phone:		*
Email:		*
Payment Information
Payment Method:	Credit Card Pledge
Cardholder's Name:		*
Credit Card Number:		*
Card Type:	Visa American Express Discover MasterCard	*
Card Expiration:	01 02 03 04 05 06 07 08 09 10 11 12  / 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 2042 2043	*
Card Security Code:		*
Matching Gifts
	My company will match my gift
Company:		*
Tribute Information
Name:		*
First name:
Last name:		*
Type:	In Memory Of In Honor Of	*
Description:		*
	Mail a letter on my behalf	*

Please contact the Patron Office at 212-501-3252 or greene@lct.org for more information.