Name: ____________________________ Donation Amount $20 $50 $100 Other___________ Check Enclosed Payable To: The Arts Council For Chautauqua County Please Bill Me For My Donation: Charge My: Visa Master Card Discover Card#_____________________ Exp. Date________ Phone: ____________________________ Email: ____________________________ Address: ____________________________ ____________________________ ____________________________ Mail Your Donations To: WRFA-LP 116 E. 3rd Street Jamestown, NY 14701