Date: / / New Member - Renewal (Circle one) |
Name |
Address |
City State ZIP __________-________ |
Telephone ______-_______-_________________ |
|
(Circle one) Mail application & payment to: Individual $15.00 Friends of the VAC Senior / Student 10.00 Membership Family 20.00 25 Lantern Lane Patron 25.00 Vernon, CT 06066-4901 Sponsor 50.00 |
To PRINT form. Right click, select PRINT.
Mail completed form with payment to:
Friends of the Vernon Arts Commission
Membership
25 Lantern Lane
Vernon, CT 06066-4901