Cultural Council of Georgetown County
Membership & Renewal Form
- For a new membership, or to renew your existing one, please print out this form, complete it, and mail today to:
-
Cultural Council of Georgetown County
PO Box 2626
Pawleys Island, SC 29585
Name: _______________________________________________________
Address: _____________________________________________________
City, ST, Zip: ___________________________________________________
Home Phone: __________________ Bus.
Phone: _____________________
E-Mail: _______________________________________________________
Please Check Appropriate Info: ___ New
Membership ___ Renewal
Individual Memberships: |
Corporate Memberships: |
____ Student ($10.00)
____ Individual ($25.00)
____ Family ($50.00) |
____ Supporting ($100.00)
____ Patron ($250.00)
____ Gold Patron ($500.00) |
____ Silver ($1000.00)
____ Gold ($2000.00)
____ Platinum ($3000.00) |
Payment Information:
Enclosed is my tax deductible check for $____________________
Visa/Master Card #:
______________________________________
Exact Name as Listed on Card:
_____________________________
Expiration Date_________________________________________
Signature _______________________________________________
Today's Date _________________
|
