Membership Application

 First, Last Name

 Street Address   

 City, State, Zip   

 Daytime Phone   

 Evening Phone    

 Email address     

 Membership Category:

Angel, $2,500             Benefactor$1,000

Sustaining, $500          Patron, $200

Friend, $100               Family, $50

Individual, $40

 Payment Method:

Check payable to The Art Center

Bill Me

Credit Card    Visa     MC    Discover

Credit Card #  

Expiration Date