Membership Application Form

 

Student

 $35
Senior $35
Adult $45
Family $65
Business $75
Patron $125
Benefactor $275 and above
$10 Donation = 15% of (1) child's art class
   
Donation ___________
 
Name ______________________________________________________________

Address ____________________________________________________________

City _____________________ State ____________ Zip ______________________

Phone (___)___________________ Email _________________________________

 
Method of Payment  cash
   check
   credit card
   card number ______________________________________________
   exp. date ____/____
 

Mail to or drop off at:
Maude Kerns Art Center
1910 E. 15th Avenue - Eugene, Oregon 97403