Membership Form

Name:
_______________________________________________________________________

Address:
_______________________________________________________________________

City, State, Zip
_______________________________________________________________________

Phone: day
__________________________________

Pnone: evening
__________________________________

My membership is: new / renewal

I would like to recieve artist mailings: yes / no

Membership Level:

$5 Student

$15 Artist / Senior Citizen

$25 Individual

$50 Supporting

$100 Sustaining

$500 patron

Make All checks payable to SPACES

Amount Enclosed: _____________________

Does your Employer have a matching gift program?

Form enclosed/ Will follow

Not Applicable

SPACES memberships are valid for one year and are tax deductible to the extent allowed by law.

SPACES
2220 Superior Viaduct
Cleveland OH 44113

email: spaces@apk.net

URL: www.spacesgallery.org