19th Street Membership

Yes! I want to help support quality cinema at the 19th Street Theatre!

____	$40 Basic Individual Membership
	$5 admission to all films all the time for member, film schedules mailed to your home
____	$65 Couple Membership
	$5 admission to all films all the time for couple, film schedules mailed to your home
____	$100 "Director"
	$5 admission to all films all the time for member and guests, film schedules mailed to your home
____	$250 "Star"
	6 free admission tickets, $5 admission to all films all the time for member and guests, film schedules mailed to your home

____	$500 "Producer"
	10 free admission tickets, $5 admission to all films all the time for member and guests, film schedules mailed to your home
____	Contributor
	I can't give $40 right now, but here's my contribution of $______

Name:	_______________________________________________________
Address:	_______________________________________________________
City:	_______________________	State:	_____	Zip:	_________
Telephone:	_______________________	E-mail:	______________________

____ My company will match my gift.
Company Name:	____________________
Phone:	____________________
Please enclose matching gift form.

Please print your name and address as you wish them to appear in our records. (Couples give both names.) Complete the form and return with payment (checks made payable to 19th Street Theatre) to:

Membership
19th Street Theatre
527 N. 19th St.
Allentown, PA 18104-5020

Or you can bring your membership form by the theatre.