Arts Benicia Membership Form

Name

Address 

City
State                

Zip

Home Phone 
Work Phone
Fax 
E-Mail

New members joining at the $35 or above level receive a FREE Arts Benicia T-Shirt!

T-Shirt Size Small     Medium     Large     X-Large

 

Membership Categories and Pricing (Check one)

Student/Senior - $20
  Artist - $25
  Individual - $35
  Family - $60
  Business - $100
  Friend - $150
  Donor - $250
  Patron - $500 - 999
  Benefactor - $1,000 - 4,999
  Corporate Sponsor - $5,000 - 10,000 +

To pay with Visa or Mastercard:

Card Type

  Visa       Mastercard    

Card Number

Expiration Date

Name on Card

Security Code (3 digit number on the back of the card)

To pay with Check or Money Order, make payable to:  Arts Benicia

Mail completed form to:   Arts Benicia, 991 Tyler Street, #114, Benicia, CA 94510
or
Fax to: (707) 747-0241

Comment or Question:

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