Membership Application

Name
Address
City
ZIP Code
e-mail
Confirm e-mail
Phone

I want to support the programs of the Lake County Arts Council at the
following tax deductable level:

$10 Student $25 Individual
$35 Family $50 Patron
$50 Small Business $100 Donor
$100 Business Donor

Volunteer? I would like to get involved in:

Gallery host Art in Public Places
Soper Reese Theatre Contact me

Yes, I would like to be added to the LCAC e-mail list.
Yes, I would like to be contacted about displaying my work in the Gallery.

For more information, call 707-263-6658
or drop by the Gallery at 325 North Main Street in Lakeport.


or return print and return this form to:
Lake County Arts Council
PO Box 247
Lakeport CA 95453

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