Please use this form for mail-in contributions. Once completed, detach the bottom section and mail
along with your check or money order to:

Restless Native Dance, Inc.
Prince Street Station
P.O. Box 362
New York, NY 10012

*Keep this portion for your records

Contribution made to Restless Native Dance, Inc.

Date:_____________________

Amount:___________________

Check/MO#:_______________

All contributions are tax-deductible as allowed by law.

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*Please make your check payable to: Restless Native Dance, Inc.

Date:_____________________

Please accept my contribution of $__________________.

Name:___________________________________________________

Address:_________________________________________________

City:_______________________________ State:________ Zip:_____________

Email Address (optional):_____________________________________