Yes! Please accept this contribution of $_______for ____ seats (at $200 each) in the Beltonian Theatre.
Name: ________________________________
Address: ______________________________
City: _________________________________
State: _____________ Zip: _______________
Phone: _______________________________
# of seats: _____ x $200 ea. = $_______

--All Plaques will say--
“This seat was sponsored by:”

I would like the following inscriptions on the seat(s):
(Maximum to of two lines with 30 characters each line)

Seat #1: ________________________________ ________________________________

Seat #2: ________________________________ ________________________________

Seat #3: ________________________________ ________________________________

Seat #4: ________________________________ ________________________________

Seat #5: ________________________________ ________________________________

Seat #6: ________________________________ ________________________________

Participation in this fund raising program buys you a plaque with your inscription on it which will be placed on one of the Beltonian Theatre seats. Your donation per seat will entail a free movie/play pass (3 seats/3 passes), but will not entitle you to the seat(s) you have sponsored. Beyond the free pass, your donation does not include any admission costs to events and again, does not entitle you to the use of the seat with your inscribed plaque.

Please mail this form and payment to:
Beltonian Seat Project
P.O. Box 807
Copperas Cove TX, 76522

For more information, please call 254-394-6849 or emailus@beltonian.com