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Moore Area Arts & Humanities Council
MEMBERSHIP FORM
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| First Name: |
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DATE: |
| Last Name: |
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Check one: [ ]New [
]Renewal |
Name of Company:
(if Corporate Membership) |
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TYPE of
Membership
(check one):
[ ] Youth (ages 18&under): $5/yr.
[ ] Individual: $15/yr
[ ] Family: $25/yr
[ ] Patron: $50/yr
[ ] Corporate: $100/yr
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| Address: |
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| City, State, ZIP |
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| Work Phone: |
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| Home Phone: |
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| Email Address(es): |
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| Website Address: |
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Amount Enclosed: $ |
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Check # |
Memberships are based
on the calendar year.
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Type |
ANNUAL DUES
(Jan - Mar) |
| Youth |
$5.00 |
| Individual |
$15.00 |
| Family |
$25.00 |
| Patron |
$50.00 |
| Corporate |
$100.00 |
| Non-Profit
Organization |
$25.00 |
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