The Art Center - Membership Form

The Art Center Membership form

I would like to join at the following level:

$5,000 Sponsor

$1,000 Benefactor

$500 Patron

$200 Contributor

$100 Supporter

$50 Family

$35 Senior Couple

$35 Individual

$25 Senior Individual

$25 Student

$10,000 or more Life Member

I am interested in making a planned gift.

____________________________________________

_____________________________________________________ Name

_____________________________________________________ Address

_____________________________________________________ City, State, Zip:

(______)______-____________|______________@___________ Phone E-mail

_____________________________________________________ Referred by

New membership

I would like to volunteer.

I am an artist.

Renewal membership

My check is enclosed.

Please charge my Visa MC

Account#__________________________ExpirationDate_________

Signature:______________________________________________

Thank you for your tax deductible contribution. Please return this completed form with payment to:

The Art Center | 1803 North 7^th Street | Grand Junction, CO 81501 | Phone: (970)243-7337 | FAX: (970)243-2482