2012 Gala Reservation Form

Please note that no credit card information is recorded or retained on the Harvard Schools Trust website. When you complete the form below, you will be taken to PayPal's secure website, where you can use a PayPal account, a credit card, or a debit card.

If you prefer to pay by check, please download the pdf version of the form, print it and fill it out, and send it with a check payable to the Harvard Schools Trust, PO Box 450, Harvard, MA 01451.

Thank you for supporting the Harvard Schools Trust!

Donor Information

First Name(s)*

Last Name*

Optional Second First Name

Optional Second Last Name

Country*

Mailing Address*

City/Town*

State/Region*

Postal Code*

Email Address*

Telephone

Gala Options

I would like to be a Gala Patron for $250 (includes two Gala tickets, plus sponsorship of two teachers, plus recognition on the HST website and in the Gala playbill program)

Please list my name(s) as patron(s) I prefer to be an anonymous patron

Number of Gala tickets at $50 each

Number of senior (age 65+) Gala tickets at $40 each

Number of tickets to only the theater performance at $15 each

I'd like to contribute toward an HES or Bromfield teacher's attendance at the Gala. Enter amount at right.

I'm unable to attend this year's Gala but wish to make a tax-deductible donation to the Trust. Enter amount at right.

I'm joining the Trust, or renewing my membership for 2011-12. (Individual/Family Membership: $35; Sponsor: $100; Patron/Corporate: $500). Enter amount at right.

Total: $0.00