LOUISA ARTS CENTER
Donor Information

Yes, I would like to contribute to the Louisa Arts Center fund in the amount of:

$_______________________

My check (payable to the Louisa Arts Center) is enclosed._____

Name: ____________________________________________________

Address: __________________________________________________

City: __________________________State: _______ Zip:____________

Phone: _________________________________

E-mail: ___________________________________________________
(if you wish to receive notifications of events and happenings)

Signed: ______________________________________________

Mail to:
Louisa Arts Center
P.O. Box 2119
Louisa, VA 23093

Phone 877 774-ARTS

My employer___________________________________________

makes matching gift contributions. Yes____   No____ Maybe______