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

Playwrights’ Workshop Montréal
5337 Blvd. St-Laurent, Suite 240
Montréal, QC H2T 1S5
Tel: (514) 843-3685
Fax: (514) 843-9384
www.playwrights.ca

I want to invest for the future.

O Donation: $50
O Donation: $100
O Donation: $200
O Donation ... please specify amount: $_______

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
______________________________________________________________________________________________________

Special message to honouree:_____________________________________________________________________________

Address to send personalized letter:
______________________________________________________________________________________________________
______________________________________________________________________________________________________

Name ________________________________________________________________________________________________
Address ______________________________________________________________________________________________
City _________________________ Province ____________ Postal Code _________________________________________
Home phone: (       ) ____________________ Work: (       ) ____________________________________________________
E-mail _______________________________________________________________________________________________

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