Powell River Arts' Council Membership Application

2009 - 2010 MEMBERSHIP & DUES

 For Program/Fiscal Year September 1, 2008 – August 31, 2009

To become a member, please complete the form below and mail or deliver a cheque in the appropriate amount to

Powell River Council for Arts, Culture & Heritage
201A-7373 Duncan Street  Google® MAP
Powell River, BC   V8A 1W6

Press Control P to print this form for your records. You will be contacted to confirm membership and receipt of payment. A formal receipt will be issued upon request.

MEMBERSHIP DETAILS

Name and address of person, group or organization:

Contact Information:

Name of Representative:
(if applicable)

Email:

Phone Numbers:
(main and alternate)

CATEGORY OF MEMBERSHIP - please select one
Individual - $15
Groups:

Small: up to 20 members - $25

Large: over 20 members - $40

Business - $40

Patrons / Sponsors - Donation

Discipline:
(select one or more)

Number of Members in Organization:

Culture/Heritage

Dance

Drama

Film/Video

Literature

Music

Visual Arts

Other

Comments or Suggestions:

Website: