Studio magazine (Fall/Winter 2017–18)

Page 113

Yes! I want to be a Member of The Studio Museum in Harlem. (tear here)

Mr.

Ms.

Mrs.

Other

1 Year Renewal Gift

Name of membership holder

MEMBERSHIP Donor $500 Associate $250

Name of additional Member (Family/Partner level members and above)

Supporter $125 Family/Partner $75 Individual $50 Student $25* Senior $25*

Address

STUDIO SOCIETY Studio Society $1500 City

State

Zip *(Student/Senior Membership will not be processed without a copy of a valid ID)

Work Phone

Home Phone

I have enclosed my check (make check payable to The Studio Museum in Harlem)

Email Address

Please do not make my name, address and other information available to third-party providers. Please list as Anonymous.

MAIL TO The Studio Museum in Harlem 144 W. 125th St. New York, NY 10027


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