Please print this form and mail it to the following address:

Playwrights’ Workshop Montréal / Atelier de dramaturgie de Montréal
5337 Blvd. St-Laurent, Suite 240, Montréal, QC H2T 1S5

Or donate by phone or email:

Tel: (514) 843-3685 Fax: (514) 843-9384
E-mail: info@playwrights.ca

I want to support Playwrights' Workshop Montréal's mandate to nuture and cultivate Canadian playwrights and theatre in Canada.

O Donation: $10
O Donation: $50
O Donation: $200
O Donation ... please specify amount: $_______

Become a member - recieve the benefits and keep up to date on what's happening in the community.

O Writing Membership: $55
O Supporting Membership: $45
O Student Membership: $20

O Cheque enclosed
O Bill my Visa / Mastercard, number: _________________________ Exp. date __________________

For in honour / memory donation only. Please check one and complete
O In honour of
O In memory of
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Special message to honouree:_____________________________________________________________________________

Address to send personalized letter to honouree:
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Name ________________________________________________________________________________________________

Address ______________________________________________________________________________________________

City _________________________ Province ____________ Postal Code _________________________________________

Home phone: (       ) ____________________ Work: (       ) ____________________________________________________

E-mail _______________________________________________________________________________________________

Playwrights’ Workshop is a registered Canadian Charity (no. 11909 4738 RR 0001). Thank you for your support.