Beginning Date First Name Last Name Status: 2020 2022 2023 2024 2025 2026 -comp- Life Patron Associate Telephone 1 Telephone 2 Street Address City State/Province Zip/Postal Code E-mail 1 Web Site Last Payment/Donation Date Check # or Merch Desc Amount/Value $ Notes Omit member from Distribution List given to Society Members Omit member from Distribution List given to Art Suppliers Member will serve as a VOLUNTEER doing: Member wishes to receive PRINTED COPY of Newsletter.
SAVE = ENTER