A member of the Theatre de la Jeune Lune development staff will be contacting you for your credit card information to complete this gift form. To make a gift by check, please print this form and mail it to the address below.

First Name/Last Name:
Significant other's first name/last name:
Address:
City/State/Zip:	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KA 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
Email:
Home Phone:
Business Phone:
How do you prefer to be contacted?	Home phone Business phone Email
Gift amount:	$25 $50 $100 $150 $250 $500 $1,000 Other Other:
Do you or does your significant other work for a company with a matching gifts program?	Yes No
Company Name:
Your comments or questions are welcomed:
Theatre de la Jeune Lune Development Department 105 North First Street Minneapolis, MN 55401   Phone: 612-332-3968 Fax: 612-332-0048