GIVE THE GIFT OF A PROFILE DONATION

Profile Theatre gift donations can be made in honor of friends and
relatives for any occasion and allows us to continue creating great theatre
for the Portland community.

Please fill out the following form to make a donation as a gift.  Make sure
to fill in the Dedication Acknowledgment Information so we can alert the
recipient of this gift.

Amount of Gift:*

GIFT RECIPIENT INFORMATION

Dedication Type in honor in memory on behalf

Dedication Honoree Name

Personal note to be included with donation

GIFT RECIPIENT ACKNOWLEDGEMENT INFORMATION

Acknowledge by None Email Mail

First Name

Last Name

Address

Email

ACKNOWLEDGEMENT

For all donations, please list your name(s) as you would like it to appear in our program listings (separated by commas).

Name(s) to acknowledge (If you would like to remain anonymous, please enter "anonymous"):*

I would like this donation to remain anonymous

BILLING AND PAYMENT INFORMATION

Salutation Mr. Ms. Mrs. Dr. Prof.

First Name*

Last Name*

Employer

Address*

City*

State* UNITED STATES Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming CANADA Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

Zip*

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Email*

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