| Print out, complete, & mail to The ART Mission, 61 Prospect Ave., Binghamton, NY 13901 Name: _______________________________________________________ Address: _______________________________________________________ City/St/Zip: ________________________/_____/_________ Phone: _____-__________ Email: ________________________________ Date ________________________________ MEMBERSHIP CATEGORIES ____ INDIVIDUAL / ARTIST $35 (includes one free pass!) (plus ONE ____ FAMILY $50 (includes TWO free passes!) ____ SUPPORTING $100 (includes FOUR free passes!) ____ PATRON $500 (includes FOUR free passes and a weekday gallery rental) ____ SPONSOR $1000 (includes a mon-thus theater and gallery rental!) ____ SEAT DONATION (engraved nameplate) $ 300 what would you like your nameplate on the seat to say? : _____I'm making an additional tax-deductible donation of $_______ to support art in our community through the ART Mission! We are a 501(c)(3) non-profit corporation; donations are fully deductible as allowed by law. SPONSORSHIP ____$ 1000 CORPORATE or Other amount $ _____ PAYMENT : Check: Please make your check payable to: The ART Mission. Credit Card: Visa___ MC ____ DISCOVER ____ Card No._______________________________________Expiration___ /___ Your Signature: _______________________________________________________________ THANK YOU & WELCOME! |