Name:

Profession:

Company/Area of Business:

Mailing Address:

Country:

Contact Tel:

Contact E-mail:

Fax:

Your Supporting Website(s):

Supporting newspaper/trade paper articles, TV interviews, accomplishments, perhaps previous philanthropy in this field that might be interesting or relevant:

The level and area(s) you are most interested in sponsoring (voice, recordings, productions, etc.):

Particular reasons why:

If requested, can you provide proof of your identity and the financial means to be a patron at this level? YesPrefer Not To

If the initial meetings go well, to prove your seriousness and means, would you be willing to donate an initial, non-refundable deposit of $5,000 before planning any project together? YesNo

Would you be willing to come to Costa Rica and meet in a public setting to talk about our project? DefinitelyNo

If not, would you be willing to have a teleconference via the Internet? YesNo

If wishing to commission a work (on what subject, what genre, text, i.e. details?)