Print and mail or FAX completed application to
Northwest Children's Theater and School
Northwest Neighborhood Cultural Center
1819 NW Everett St., Suite 206
Portland, OR 97209-2189
Fax #: 503-222-4130
Phone: 503- 222-2190

Name:

Address:

City:
State:
Zip:

Phone (day):                                                           (evening)

Tax-deductible donation amount: $__________

Payment information:
Check (payable to Northwest Childrens Theater & School) enclosed _____
Visa/MC# _______-_______-_______-_______ Expires _______
Signature _____________________________________________

NWCT is a 501(c)(3) non-profit organization; donations are tax-deductible. We can provide appropriate documentation for your tax records. 

Thank you for your generous donation.