GCCCA 2011-12 Season Subscription/Ticket Order Form
        Note: Membership subscription covers admission to all five of the 2011-12 season's concerts

To help support the full cost of our concert series and our Educational Outreach program for school children, please consider augmenting your membership payment with a  tax-deductible donation. DONOR PLANS:
___	New	__	Student(s)	@$15	_____	___	Friend	$40
___	Renewal	__	Adult(s)	@$45	_____	___	Patron	$70
		__	Early Bird(s)	@$40	_____	___	Benefactor	$130
			(if received by 6/30/11)			___	Sponsor	$240
__________________		__	Tickets @$20		_____	___	Sustainer	$350
(Concert Name or Date)						___	Angel	$500
			Total Purchase		_____	___	Other	______
			Donation		_____
			Total Payment		_____

Children of members (up to age 17) are admitted free of charge.

Name _______________________________              Telephone ___________________

Address _____________________________              City/State/Zip ________________

E-Mail ______________________________             

Make checks payable to GCCCA                                Check # __________

or provide the following credit card information:

    Card Type: Master Card __  Visa __ Discover __

    Card Number: _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _        Expiration Date: _  _ /_  _

    Security Code: _  _  _

    Name on Card: _______________________  Signature: __________________________

Mail to: P.O. Box 2722, Silver City, NM 88062

(Tickets will be mailed in early September.)

       Phone: (575) 538-5862   e-mail: gccca@gcconcerts.org  Web addr.: gcconcerts.org