Special Friend of MCO

Your one season membership includes:

Your membership level may be expressed by the following contribution:

____  Platinum Baton Level ($200+)

____  Gold Baton Level ($100)

____  Silver Baton Level ($50)

____  Bronze Baton Level ($25)

Name (Please Print) ______________________________

Mailing Address    ________________________________

                            ________________________________

Phone Number  (___) _______________

List me in the program as   _________________________

Print this form.  Send your completed form along with your tax-deductible contribution to :

 The Melbourne Community Orchestra

PO BOX 411011

Melbourne, FL 32941