R. S. V. P. to the Gala by August 2, 2004

AS TIME GOES BY: REMEMBERING INGRID BERGMAN
To Benefit the Bellport-Brookhaven Historical Society Museum

Please hold at the door _____ reservations at $125 each: $______________

We wish to sponsor the work of the Historical Society by including
an additional contribution in one of the following categories:
[] Benefactor      $2,500                        [] Friend           $500
[] Patron            $1,000                        [] Supporter      $250
[] Other $____________
              Total of reservations and contributions $____________________

We are unable to attend but wish to make a contribution 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