Annual Membership Form
$________MAILBOX MEMBER ($25 - $99)
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$________PATRON MEMBER ($100 - $249)
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$________BENEFACTOR MEMBER ($250 +)
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$________DONATION (any amount)
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Name(s): ____________________________________________ Address: ____________________________________________ City: ______________________Postal Code: ______________ Phone: ______________________________________________ e-mail: ______________________________________________ Method of payment (please circle) VISA MC AmEx CHEQUE Credit Card #: _________________________________________ Expiry Date: __________________________________________ Signature: ____________________________________________ |
Please make cheque payable to Showplace, Peterborough. |