PERSONAL INFORMATION (Please list as you wish your gift to be acknowledged)

Name_________________________________________________________________

Address_______________________________________________________________

Telephone______________________ E-mail__________________________________


PAYMENT OPTIONS (choose one)

_ $____ check enclosed (payable to WAS-H) _ Please charge my $____ gift to my

_ Visa _ Mastercard _ Discover _ AMEX Account # _________________________

Name on card ___________________________ Exp. Date ________________________

Signature ________________________________________________________________
(required for all credit card gifts)

Gifts such as these enable WAS-H to continue to provide quality art exhibitions and instruction in schools, hospitals, at the WAS-H gallery and throughout the Houston community.

_ Enclosed is my company’s completed matching gift form.

_ Please remove my name from WAS-H’s patron/exhibition invitation list.

Thank you for your tax-deductible donation made payable to WAS-H, a 501 (c) (3) not-for-profit organization. Your capital campaign contribution will be permanently acknowledged on WAS-H’s patron list at the building site unless otherwise requested.