Please print this form, fill it out and mail to the address at the bottom

MUKILTEO ARTS GUILD MEMBERSHIP FORM

NAME__________________________________

BUSINESS NAME_____________________________

ADDRESS__________________________CITY______________ZIP__________

HOME PHONE_______________CELLPHONE__________________________

EMAIL_________________________________

WEBSITE________________________________

WHAT IS THE PREFERRED WAY TO REACH YOU?________________

ABOUT YOU:

CATEGORY: (PLEASE CIRCLE) VisualArt   Music    Drama    Written Word      

STYLE, SUBJECT, TECHNIQUES_______________________

MEMBERSHIP:     Membership runs July 1^st to June 30^th annually

NEW_________RENEWAL________DATE__________

SINGLE @ $25 PER YEAR                                                         $______

Please make a donation to our scholarship fund                           $______

ADDITIONAL MEMBERS @ SAME ADDRESS @ $10 EACH        $______

NAME(S)_______________________

Art category______________________

GENEROUS PATRON

     SILVER PATRON ($75 – 199 PER YEAR)                                   $______

     GOLD PATRON ($200+ PER YEAR)                                           $______

                              TOTAL                                                         $______ 

CHECKS PAYABLE TO MUKILTEO ARTS GUILD

MAIL TO:  Steve Schmalz, MAG Treasurer * 9115 53^rd Avenue West, Mukilteo WA  98275

Mukilteo Arts Guild is dedicated to promoting and fostering the arts in our community.