Putnam Arts Council
Membership Form
Thanks for choosing to
join us this year!
Name____________________________________
Address__________________________________
City__________________State_________Zip____
Phone(h)_________________________________
Phone(w)_________________________________
e-mail____________________________________
Membership category
( ) Student………………………
( ) Green……………………..
( ) Artist……………..
( ) Individual……………..
( ) Family……………………….
( ) Non-profit organization……
( ) Sponsor…………………….
( ) Business……………………
( ) Patron………………………
( ) Angel……………………….
( ) Donor……………………….
(
(
$ 15.
$ 20.
$ 25.
$ 25.
$ 40.
$ 50.
$ 100.
$ 100.
$ 250.
$ 500.
$1,000.
) I’m a new member.
) I’m renewing my membership
Your check will be your receipt for tax purposes.
All but $5.00 is tax deductible.
Print this form and mail it to:
Putnam Arts Council P.O. Box 156
Mahopac, NY. 10541
Checks should be made payable to:
Putnam Arts Council
Questions: Contact us at (845) 803-8622