Membership Application (Print Version) Millburn-Short Hills Art Center
Print this form, fill in the information, and mail with a dues payment to ANASTASIA MANCUSO, 79 Old Army Road Bernardsville NJ 07924-0000
Name: __________________________________________________
Address: Street _____________________________________ City_________________________
State/Zip: ____________________
Home Tel. ______________________
Cell Tel. ____________________________
Alternate Tel. ____________________
Email _______________@______________.________
Website URL, if you have one: ______________________________
Please Check One of the following:
____ General or regular member at $25
____ Senior or Student member at $20
____ Family Senior at $35
____ Family Regular at $50
____ Patron at $35 for senior and $50 for regular.
We always need volunteers for our shows, committees, and other events. We are also interested in considering you for a trustee or chairperson position. If you are interested please indicate so here:
_______ I am interested in working on a committee
_______ I am interested in chairing a committee
_______ I would like to be considered for a position as a trustee
Sign your name here___________________________________________
Date: ________________
