Central Pennsylvania Womyn's Chorus
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Support the Chorus You Love with a Monthly Contribution

We are a 501 (c)(3) organization under the Internal Revenue Code. Contributions are tax-deductible if you itemize your federal income tax return. To make an automatic monthly contribution:

  • Print this form
  • Fill it out
  • Give it to the treasurer, or --->
  • Mail to CPWC
    P.O. Box 60426
    Harrisburg PA, 17106-0426
Yes! I love the chorus and want to help it give voice to our community!
UNTIL FURTHER NOTICE, PLEASE DEDUCT THE AMOUNT INDICATED FROM MY BANK ACCOUNT
(deductions made on the first of each month)

Name of Bank or Credit Union:

_______________________________________________________

Bank Routing Number _________________________

Account number _______________________

PRINT Your Name as it appears on your bank account

_____________________________________________________

PRINT Name(s) as you would like them to appear in our concert program book. (If your individual bank account is being charged and you are part of a couple, you may want to list both your names. You may choose to be listed under a nickname.)
If you put nothing here and do not ask to remain anonymous, we will use your name as it appears on your bank account.

_______________________________________________________________________________________________

OR ______ I prefer my donation remain anonymous

PRINT Address ________________________________________________________________________________________________

Telephone Number ______________________________ Email (Optional, but we might need to contact you):______________________________________

Amount to be charged monthly to my credit card (check one):

______ $100 ______ $75 ______ $50 ______ $25 ______ $20 ______ $15 ______ $10 ______ $5 (minimum)

______ Other ($5 minimum, please): $ ______________

Signature _________________________________________________________ Today's date: _____________________

THANK YOU FOR HELPING US GIVE VOICE TO OUR COMMUNITY!

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