HIDDEN TREASURES OF THE
BELLPORT-BROOKHAVEN HISTORICAL SOCIETY

_____ I/We will attend the party on Sunday, August 14, 2005

_____ *Sponsor at $2,500 per person
_____ *Benefactor at $1,000 per person
_____ *Patron at $500 per person
_____ *Supporter at $250 per person
_____   Friend at $125 per person
 
* Will be acknowledged in the program

_____ Enclosed is my check in the amount of $ ___________

I/We are unable to attend but have enclosed a donation of: $ ___________

Name __________________________________________________________

Address ________________________________________________________

City ________________________ State_______________ Zip____________

Please make checks payable to: The Bellport-Brookhaven Historical Society.
Reservations and Contributions are tax deductible to the extent allowed by law.
 

Return to:	Bellport-Brookhaven Historical Society
	P.O. Box 47
	Bellport, New York 11713

Please R.S.V.P. by August 2, 2005

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