Saturday Evening, August 4th, 2007
Opening Night Summer Gala
BELLPORT-BROOKHAVEN: THEN AND NOW
To benefit the Bellport-Brookhaven Historical Society Museum

Name ___________________________________________________________

Address _________________________________________________________

City ____________________________  State _________  Zip ____________

Please hold at the door _____ reservations @ $125 each:     $ ___________

We wish to include an additional contribution of:                 $ ___________

We are unable to attend but wish to make a contribution of: $ ___________

                                                                      Total Enclosed:    $ ___________

The society will acknowledge your support in the following categories:
Benefactor: $2,500; Patron: $1,000; Friend: $500; Sponsor: $250
Please make checks payable to The Bellport-Brookhaven Historical Society and return to:
PO Box 47, Bellport NY 11713
Donations and all but $40 per reservation are tax deductible.
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