Please print this page, fill out and fax your sponsorship to Ballet Oklahoma.
Fax to 405.843.9894
THANK YOU!

Please debit my:
( ) Visa ( ) MasterCard ( ) American Express ( ) Discover

For a total of: $_______________________ every month.

Credit Card No: _________________________________________

Expiration Date: __________________

Signature: ______________________________________________

( ) Please list my name as shown below
( ) I would like my donation to remain anonymous

Name:__________________________________________________

Address: ________________________________________________

City: _____________________ State : __________ Zip: _________

Phone:
(bus) ________________________

(res) ________________________

Email _____________________________

By completing this form, I authorize Ballet Oklahoma to automatically charge my credit card each month. Payments will be processed the 1st on each month.

Signed: __________________________________

Date: ____________________

Please fax, phone or email your sponsorship to Ballet Oklahoma.

Phone: 405.843.9898
Fax: 405.843.9894
Email: balletoghockman@sbcglobal.net