Membership Info

Print this form, complete and fax to (404) 364-8556
Or mail to: Oglethorpe University Museum of Art / 4484 Peachtree Road, N.E. / Atlanta, GA 30319


Oglethorpe University Museum of Art
MEMBERSHIP APPLICATION


Please indicate your selected level of membership:
 
___ Individual $35   ___ Director: Individual $75
___ Family / Dual $55   ___ Director: Family/Dual $150
___ Senior Citizen $20   ___ Patron $100
___ Senior Citizen Dual $30   ___ Sponsor $250
___ Student, Faculty & Staff $25   ___ Donor $500
        ___ Benefactor $1,000


My Contribution: $____________ ___ New ___Renewal




Name______________________________________
Address ___________________________________
City_______________________________________
State __________________ Zip_________________
Telephone__________________________________
Email Address_______________________________



____I am interested in becoming a museum volunteer

Indicate method of payment:

___ My check is enclosed.
  (Payable to Oglethorpe University Museum)
___ Please charge to my credit card:
  ___Mastercard ___Visa ___American Express
  Card Number______________________________
  Expiration Date ____________________
  Your Signature ____________________________


Thank you for your generous contribution and support of our museum!