Membership Form for Creative Way USA

Imagination has always had powers of resurrection that no science can match. --Ingrid Bengis

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Creative Way USA
Annual Membership Form

Member Information
(* = Required Entry)

Membership Level
(Select Appropriate Membership Category)

First Name*
Last Name*
First Name
Last Name
Group Name
Address*
City*
State*
Zip/Postal*
Country*
Phone*
Fax
Email*

All Membership Fees are Annual (in U.S. Funds)
	General Member	Free
	Friend Full-Time Student	$20.00
	Friend Individual	$45.00
	Friends Dual/Family	$65.00
	Supporter	$100.00
	Sponsor	$250.00
	Benefactor	$500.00
	Patron	$1000.00
	Silver Patron	$2500.00
	Gold Patron	$5000.00

Membership Category Information (Check All That Apply)

Artist Categories:

Fine Art	Music	Drama
Dance	Literary	Graphic
Digital	Media	Ceramics
Other

Organization/Business:

NonProfit	Charity	Gallery
Museum	School	Library
Agency	Business	Manufacturer
Supplier	Press/Critic
Other

Individuals/Families:

Collector	Educator
General Public	Agent
Art Patron
Other

Other/Additional Categories:

You can submit this form online or you can print it out to fax or mail it in. Click for Print Version

Credit Card Payment:

Name on Card:
Billing Address:
Amount:
Card Type:
Expiry Date:
Card #:

Creative Way USA
2668 Honolulu Ave. Suite A
Montrose, Ca. 91020 USA
Fax: 818-249-6653

Please make checks or money orders payable to "Creative Way USA"

International Members:You must purchase a draft payable in U.S. funds drawn on a United States bank.

Questions? Tel: 818-249-5733, M-Fri 9-5 PST, E-mail: cwusainfo@creativewayusa.com or use our on-line contact form here.

YOU CAN HELP!

Learn how you can contribute to this dynamic and creative group.

More Info

Make a tax-deductible donation today!

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