MEMBERSHIP FORM

NAME *

First Name Last Name

PHONE *

Area Code Phone Number

EMAIL *

ARE YOU AN ARTIST?

No Yes

ADDRESS *

Street Address

Street Address Line 2

City State

Zip Code

SPOUSE NAME

First Name Last Name

SPOUSE PHONE NUMBER

Area Code Phone Number

SPOUSE EMAIL

SELECT YOUR MEMBERSHIP LEVEL *

$80 - ART (Alliance for Renwick Tomorrow) $125 - Individual Donor $200 - Dual Donor $300 - Individual Sponsor $500 - Dual Sponsor $1000 - Individual Caucus $1800 - Dual Caucus $500 - Gallery (exclusively for galleries and art organizations)

TOTAL

PAYMENT

USD Description

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code