MEMBERSHIP APPLICATION:

NAME__________________________________________________________________________

LOCAL ADDRESS_________________________________________________________________

______________________________________________________________________________

PHONE___________________FAX___________________E-MAIL__________________________

SUMMER ADDRESS________________________________________________________________

______________________________________________________________________________

PHONE___________________FAX___________________E-MAIL__________________________

TYPE OF MEMBERSHIP:

Individual____$60 - Couple____$75 - Family____$100 - Corporate___$250
Annual) Donor____$300 - (Annual) Benefactor____$500
(Annual) Angel ___$1,000 - (Lifetime) Angel ___$2,000

PAYMENT METHOD:

Cash______ Check_______ Visa_______ MasterCard_______

Credit Card Account Number_______________________________________________

Expiration Date__________Signature_______________________________________

Please complete this form and send with your remittance to:

Venice Art Center
390 Nokomis Avenue South
Venice, FL 34285