If you wish to pay by check, please fill out this form Name: ___________________________________________________________________ Address: _________________________________________________________________ City, State, Zip: ___________________________________________________________ Phone: __________________________________________________________________ Email: ___________________________________________________________________ How did you hear about A BroaderWay Foundation/Camp BroaderWay? W ant to join the fun? Purchase a Table or Tickets: ______ “Director” $6,000: Priority table for 8 & gift for each of your guests (limited availability) ______ “Lead” $4,500: Preferred table for 6 & gift for each of your guests (limited availability) ______ “Ingenue” $600: Reserved seating ticket ______ “Ensemble” $300: Open seating ticket Can’t join the fun but want to support ABW ’s mission? Be a 2015 Producer ______ Executive Producer (Minimum of $5,000) ______ Associate Producer ($2,500-$4,999) ______ Producer ($1,501-$2,499) Be a 2015 Sponsor ______ Sponsor a Camper. Specify number of Camper(s) ______ ($1,500 Per) ______ Sponsor the NYC Original Performance ______ (Minimum $1,000) General Donation $_______________ Please make your check payable to “A BroaderW ay Foundation” and mail along with this form to: A BroaderWay Foundation c/o Burton Goldstein & Company, LLC 420 Lexington Avenue, Suite 2520 New York, NY 10170