MEMBERSHIP FORM

Name: ________________________________________

Address: ______________________________________

             ______________________________________

Phone: ________________________________________

E-mail: ________________________________________

Membership in the CAC is open to anyone interested in supporting our goal in the field of Visual Arts.  All members receive the Schoolhouse Quarterly and membership card.  Some programs have a reduced fee for members.  New members are welcome at any time.  Dues and renewals are received by January 31^st of the calendar year.

Mail remittance to:

            David Lesinski

            5877 Feddick Road                                       Patron $50

            Boston, NY  14025                                       New Member $20

Make checks payable to:                                                 Renewal $20

The Centennial Art Center of Hamburg, Inc.                        Junior (18 or under) $15

Please print application form and fill out completely. Send a self-addressed stamped envelope with your dues and the completed application.