Women's Committee Dues Payment Form

Please complete the form below and click on "Submit" to confirm your participation in the Women's Committee of The Washington Ballet this season! Your contribution is fully tax-deductible donation.

To submit this form, all "*" fields must be filled in.

2020-2021 Dues: $300

Salutation Mr. Ms. Mrs. Mx. Dr. Prof. Admiral Ambassador Capt. Chief Col. Congressman Councilwoman Count Countess Father Gen. His Excellency Hon. Judge Justice Lady LTC Major General Mayor Miss Prince Queen Rabbi Rev. Senator Sir The Honorable

First Name*

Last Name*

Company

Spouse's Name

Children's Name(s)

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*

Phone*

Email*

Confirm Email*

Please sign me up for your e-newsletter

Payment Info

Acknowledgement

For all donations, please tell us how you would like to be listed in the program (i.e. Mr. & Mrs. John Smith; Dr. John Doe and Mrs. Jane Doe; etc.)

Name(s) to acknowledge