Individual Membership Application

Categories of membership:

Individual Membership - $1,000
Fast Track - 3 year - $500, $750 & $1,000
Associate Membership - $500

First Name

Last Name:

E-mail Address:

Mailing Address:

City:

State: Zip Code:

Telephone Day Time:

Telephone Night Time:

Fax Number:

Best Time To Call:

How did you hear about us?:

Comments:

Please send your membership contribution to:

Membership Funding Arts Network
P.O. Box 331864
Miami, FL 33233-1864