Visions Art Museum - Membership Application

Stills from a Life by Dominie Nash,

Through the Woods by Connie Scheele, 85 x 37 inches

Please enter my membership in Quilt Visions in the following category:
	New Renewal
Type of Membership:	Student - 1 year ($25)
	Individual - 1 year ($50)
	Dual - 1 year ($60)
	Family - 1 year ($75)
	Supporter/Business - 1 year ($100)
	Damask - 1 year ($250)
	Brocade - 1 year ($500 or more)
	Velvet - 1 year ($1000 or more)
If you have chosen the Brocade or Velvet membership type, please enter the amount that you wish to pay below. Please do not enter any "$" symbols or commas. Just numbers and decimal points.
Amount of Donation: $
First Name:
Last Name:
Street Address 1:
Street Address 2:
City:
State/Province:
Zip/Postal Code:
Country:
Phone (Day):
Phone (Evening):
Fax:
Email:
I will pay by:	PayPal
	Credit Card
	Check or Money Order