Quilt Visions - Membership Application

Striped Formations by Judy Langille

Striped Formations
by
Judy Langille
© All rights reserved

Intrusions by Robert Leathers

Intrusions by Robert Leathers
© All rights reserved

Membership Application

Please enter my membership in Quilt Visions in the following category:
New Renewal
Type of Membership:
	Individual - 1 year ($40) Individual - 2 year ($70) Supporter - 1 year ($100) Associate - 1 year ($250) Benefactor - 1 year ($500 or more) Patron/Sponsor ($1000 or more)
If you have chosen the Benefactor or Patron membership type, please enter the amount that you wish to pay below. Please do not enter any "$" symbols or commas. Just numbers and decimal points.

Amount of Donation:	$
First Name:
Last Name:
Street Address 1:
Street Address 2:
City:
State/Province:
Zip/Postal Code:
Country:
Phone (Day):
Phone (Evening):
Fax:
Email:
I will pay by:	PayPal Credit Card Check or Money Order

Quilt San Diego/Quilt Visions
2825 Dewey Road, Suite 100
San Diego, Ca 92106
Phone/Fax: 619-546-4872
Email: visions@quiltvisions.org