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"Friends of VSA" Palette of Colors
These gifts support VSA, which promotes the creative power in people with disabilities:

Gold: $1000 plus
"Lighting the way for VSA"

Silver: $500 - $999
"Helping VSA shine"

Red: $250 - $499
"Forging VSA" forward"

Blue: $100 - $249
"Helping VSA see the potential"

Yellow: $50 - $99
"Adding sunshine to VSA"

Green: $1 - $49
"Helping VSA grow"

Join the "Friends of VSA" Palette of Colors and Add Your Name to This List!

Name:___________________________________________________________________
Address: ________________________City/State/Zip: ___________________________
Phone Number: _______________________Fax Number: _________________________
E-Mail Address: __________________________________________________________
How would you like to be listed? _____________________________________________

Please make check payable to:
VSA Florida - Palm Beach County
2728 Lake Worth Road
Lake Worth, Florida 33461

or

Pay by: Visa or MasterCard (Circle one) Amount of Donation: ____________________
Name as on Card: ________________________________________________________
Billing Address: __________________________________________________________
Card Number: ___________________________________________________________
Expiration Date: __________________________________________________________
Last three digits on back of card: ___________________________________________
Signature: ______________________________________________________________

Your gift is tax deductible as permitted by law. A gift to VSA Florida - Palm Beach County entitles you to a complimentary subscription to our newsletter, acknowledgment in our literature, complimentary Holiday Showcase tickets and other benefits during the year.

• Cindy Pijanowski
  Director
• Susan Fetner
  Performing Arts Coordinator
• Donald Perez
  Visual Arts Coordinator