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September 08, 2008 10:39 PM EDT

MEMBERSHIP FORM

Author: . 564 Reads

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FULTON STREET MEMBERSHIP APPLICATION

NAME___________________________________________________PHONE____________________DATE______________

ADDRESS____________________________________________________________________ZIP CODE________________

E-MAIL_____________________________________________URL______________________________________________

This is a Gift Membership from_________________________________________________________________________

Address__________________________________City_________________State_______Zip Code______________

Phone____________________________________Email_________________________________________

MEMBERSHIP STATUS:	NEW RENEW
MEMBERSHIP TYPE:	ACTIVE ARTIST $35 SUPPORTING ARTIST $50 FAMILY $75/YEAR STUDENT/SENIOR $25/YEAR BUSINESS $100/YEAR DONOR $135/YEAR PATRON $250/YEAR BENEFACTOR $500/YEAR VISIONARY $1000/YEAR SUSTAINING VISIONARY $2500/YEAR MY EMPLOYER PROVIDES MATCHING FUNDS

Enclosed is my tax deductible donation $___________ in addition to membership instead of membership

I am a/an ARTIST POET PERFORMER OTHER________________________________________

I am interested in

ART OPENINGS LECTURES WORKSHOPS COLLECTING ART
ONLINE REGISTRY POETRY/PERFORMANCE
VOLUNTEERING (see bottom of form)

PAYMENT OPTIONS

Check (to Fulton Street Gallery) VISA MasterCard AmEx

Credit Card #_______________________________________Expiration Date_______________

Signature________________________________________________Amount $______________

VOLUNTEER OPPORTUNITIES

Please check how often you will be able to help: ONE TIME MONTHLY WEEKLY

Please check where you would like to help: EXHIBITION WORK GIFT SHOP ART AUCTION

GENERAL OFFICE ACCOUNTING FUND RAISING

Area of expertise to share with FSG such as design skills, public relations, marketing YES NO

What would you like to offer? _____________________________________________________________________

Which day of the week and at what time is it convenient to reach you: ____________________________________

Signature__________________________________________________________________Date________________

PLEASE SEND THIS FORM TO: Fulton Street Gallery, 408 Fulton Street, Troy, NY 12180

or email completed form to fultonstreetgallery@gmail.com

Thank you for your support!

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