| Greene County Council on the Arts Membership Form | |
| I/We wish to become a member of the Greene County Council on the Arts in the following category: | |
| Senior/Student
Individual Family Friend/Business/Organization Sponsor Supporting Patron Benefactor |
$10
$25 $40 $50 $100 $250 $500 $1,000 |
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Total Membership Building Fund J. Ruben Garcia Memorial Fund Endowment Fund |
$
$ $ $ |
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| TOTAL AMT. ENCLOSED | $ |
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___ Cash ___ Check ___ MC/Visa ___ AmEx Name: _________________________________ Address: _______________________________ _______________________________________ Are you an Artist? ____ yes ____ no
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Card # ________________ Expiration Date: ____/____ City: _______________ State: ___ Zip: ______ Telephone: (____)______________ E-mail ________________________________ If yes, please complete the following:
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(Circle one or more in each discipline and media description) Discipline Media (description) Crafts Clay, fiber, glass, jewelry, metal, paper, wood, other _______________________ Dance Ballet, modern, jazz, tap, ethnic, other______________________ Design Arts Architecture, interior, industrial, fashion, graphic, other: ______________________ Folk Arts Describe: _________________________ Humanities History, science, cultural studies, other_________________________ Literature Fiction, nonfiction, poetry, playwright, other ________________________ Media Arts Audio, film, video, computer, other_______________________________ Music Composer, conductor, instrumentalist, soloist of classical, contemporary, ethnic, jazz, pop, other ______________ Theatre Director, performer, technical of stage, screen, TV/video, opera, musicals, circus, mime, other________________ Visual Arts Painting, drawing, printmaking, collage, sculpture, photography, computer, experimental, other _______________ Please use the space below to provide a more detailed
description of
your work for our resource files.
Return this form and your tax-deductible contribution:
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| Greene County Council on the Arts
398 Main Street PO Box 463 Catskill, New York 12414 |
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