R. S. V. P. to the Gala by August 2, 2004
AS TIME GOES BY: REMEMBERING INGRID BERGMAN
To Benefit the Bellport-Brookhaven Historical Society Museum
Please hold at the door _____ reservations at $125 each: $______________
We wish to sponsor the work of the Historical Society by including
an additional contribution in one of the following categories:
[] Benefactor $2,500 [] Friend $500
[] Patron $1,000 [] Supporter $250
[] Other $____________
Total of reservations and contributions $____________________
We are unable to attend but wish to make a contribution of: $___________
Name __________________________________________________________
Address ________________________________________________________
City ________________________ State_______________ Zip____________
Please make checks payable to: The Bellport-Brookhaven Historical Society.
Reservations and Contributions are tax deductible to the extent allowed by law.
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Bellport-Brookhaven Historical Society
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P.O. Box 47
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Bellport, New York 11713
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