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Print this page and use the form below or download .pdf file Don’t delay! Space is limited. Sign up to be one of 8 guests at Dinner with the Artist of your choice:Name (s)____________________________________________________________________________ Address____________________________________________________________________________ Home phone_______________________Work phone___________________Email_______________ Choose an Artist: 1st choice________________________________________2nd choice__________________________________ Please charge $_______________ on my visa mastercard name on credit card____________________________________________________ address of card holder_______________________________________________________________zip____________ credit card number_________________________________________________________ signature_________________________________________________________________ expiration date_____________________ security code ________________ You will be notified by email or phone of the location of your dinner. (15 mile radius of Georgetown) Please send $175 per person (payable to Friends of Fillmore) to: Friends of Fillmore c/o Coventry 4000 Cathedral Avenue NW, Apt. 246B Washington, DC 20016 |
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| I would like to send an additional tax-deductible contribution to Fillmore.__________________
Fillmore Arts Center
1819 35th Street, NW, Washington, DC 20007 202.282.1107 Questions? Send via email to dwaa2009@gmail.com, “DWAA 2009” in subject line or call Anne Coventry at 202.236.7405 Questions? Send via email to amasters@annemastersdesign.com, "DWAA 2008" in subject line, or call Anne Masters at 202.337.3748 Note: If an artist cancels due to illness or unforeseen circumstances, every attempt will be made to substitute another artist in the spirit of this event. |









