Membership Application - Friends of The Mary C.

Name:

Street Address:

City, state, and zip:

Email address :                                                                  Telephone:                                        Alternate telephone:

Membership type: (check one)

 
Membership Level
Annual Dues
 
Individual
$15
 
Couple
$25
 
Club
$50
 
Patron or Business
$100
 
Corporate Bronze
$250
 
Corporate Silver
$500
 
Life Membership
$1000 (not annual)
 
Corporate Gold
$2500
 
Proscenium Arch Medallion
$10,000
 

Amount $:

Method of Payment (check one)

[  ]  Check (make payable to The Mary C. O’Keefe Cultural Center)


[  ]  Credit Card

Type:  (circle one) Visa   Mastercard   Discover   American Express

Card Number:

Expiration date:

Signature: 

Mail to:

The Mary C. O’Keefe Cultural Center of Arts and Education
1600 Government Street
Ocean Springs, MS 39564