A
C J S
Print and mail this form
and check to:
MEMBERSHIP APPLICATION
We Always
Welcome New Members
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Name______________________________
Address____________________________
City_______________________________
State_______________ ZIP____________
Phone _____________________________
E-Mail_____________________________
Would you be willing to receive your newsletter by email? Yes _____ No _____
New_______ Renewal________
Annual Dues:
Individual $25_______ Couple $35________
Student $5______
Individual Sustaining $100_______
Couple Sustaining $150_________
Business/Professional $150______
Lifetime Individual $200______________
Lifetime Couple $300_________________
Individual Patron of the Arts $500_______
Couple Patron of the Arts $750_________
Angel ($100 annual in addition to dues)______
Cherub ($50 annual in addition to dues) _____
How did you hear about us?
________________________________________
ACJS has an “Angel & Cherub” program which will help support an out-of-state band for a monthly jazz party.
All donors will be listed in the newsletter.