MEMBERSHIP APPLICATION

Your Membership is CRUCIAL: Help fund educational exhibitions, events, programs, staffing and more. Play a key role in the exciting evolution that is defining our community as a fine art mecca and home of Lake County's only art museum.

Name: __________________________________________________________________________

Address: ________________________________________________________________________

City, State, Zip: __________________________________________________________________

Phone: _______________________________     Email:______________________________


Please select your Membership Level:
□   Individual                      $40                               
□   Student/Senior              $25
□   Dual/Family                   $60    

□   *Individual Reciprocal    $100+ 

□   Contributing                  $150
□   Sustaining                     $250
□   Partner                          $500
□   Patron                          $1,000

□   Benefactor                    $2,500+

□   Yes.I would also like to contribute to the
             Lake Eustis Museum of Art Endowment Fund
            
            Amount $____________________

□   Please consider me a FRIEND at no additional cost. I want to support auxillary efforts for the art museum

Payment Information:

Please make checks payable to the Lake Eustis Museum of Art.

Card Type:                    MC       V    Disc

Name of Cardholder:     ___________________________

Card Number:                ___________________________

Expiration:                    ___________________________

Signature:

*Individual Reciprocal $100 or MORE level entitles one to membership benefits and discounts at 350 North American museums. See http://sites.google.com/site/northamericanreciprocalmuseums/north-american-reciprocal-museum-listing   to locate NARM museums on the continent.

• All donations are tax deductible. 
• Ask your company if they will match your gift.
• When contributing to United Way, ChART,or United Arts of Central Florida, please designate your donation for Lake Eustis Museum of Art.
• Membership makes a great gift or a fitting memorial tribute.
• Please contact the Museum for more information.

Thank you. Your support is appreciated.

Please print and mail the completed form with payment to:

Lake Eustis Museum of Art
Attn: Membership
200 B East Orange Avenue
Eustis, FL 32726

lodensusan@gmail.com