MEMBERSHIP APPLICATION
___ Single Membership - $42.50
___ Couples - $85.00
___ Sponsor - $125 - $199
___ Patron - $200 - $399
___ Benefactor - $400 - $999
___ Contributor - $1,000 - $2,499
___ Major Contributor $2,500 - $4,999
____Underwriter - $5,000+
___ Donation In Kind
Name: ______________________________ Email_________________________
Company Name:_____________________________________
Address:____________________________________________
City:____________________ State:________________ Zip:____________
Email Address: ___________________________________________________
Telephone:______________________________________________
Print this form out on your printer, fill out and mail along with a check (made out to Sycamore Arts) to:
Sycamore Arts
PO Box 1096
Senatobia, MS 38668
Would you like to volunteer to help? Please let us know: _______________________________
