Xavier Theatre Arts Donor Levels

       q Samaritan  ($25 to $74) 

       q Saint  ($75 to $149)

       q Angel   ($150+)

                                                                                                            ____

                 First Name                              M.I.                                          Last Name

                                                                                                            ____      

                Address                         

                                                                                                            ____

            City                                                                          State                       Zip

                                                                                                            ____

                Email                                                                       Telephone

Are you a Xavier Alum?  q yes   q no  If yes, year of graduation _______

Please make your check payable to Xavier Theater Arts Gift

Xavier Theatre Arts • c/o XU Annual Fund • 3800 Victory Parkway • Cincinnati, OH 45207-7730

513-745-1030