Membership Form

Count me in! I want to get connected to the arts in Hampshire County. Please add me to the Arts Council mailing list and keep me posted on upcoming arts activities. Enclosed is payment for my membership dues.

Name(s):______________________________________Phone:____________________
Mailing address:________________________________________________________
City:________________________State_____Zip Code__________
e-mail address:________________________________________
___Individual Member $10/year ___Couple $15/year

(Newsletter, notice of events, listing in artists' registry, discounts on selected Arts Council events, vote for Council directors)

In addition to my membership, I want to encourage Arts activities with a tax-deductible donation)
___$25
___$50
___$100
___$500
$______ other amount (please specify)

My particular interests are:
___Music ___Visual Arts (2D & 3D) ___Drama ___Writing/Poetry

I would be willing to help with:

      ___Art Shows      ___Concerts       ___Art Camp     
      ___School Programs                  ___Signage
      ___Distribution of Fliers/posters   ___The web site           
      ___Other

Please make checks payable to: Hampshire County Arts Council
Send to: P.O. Box 624, Romney, WV 26757