Clone of FAA Membership Form (Integration updates FAA's CC membership list)

Become a Fairbanks Arts Member Today
Membership Level
prev next ( X )
Student / Senior (60+)/Military $ 30.00

Supporter $ 50.00

Donor $ 100.00

Patron $ 250.00

Benefactor $ 500.00
Name *

First Name Last Name
First Name
Last Name
Company
Title
Phone Number

Area Code Phone Number
E-mail *
Mailing Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Address Line 1
Address Line 2
City
State/Province
Postal/ Zip Code
Country
List me on the Fairbanks Arts E-mailing list as:

Visual Artist Literary Artist Performing Artist Cinema Artist Interested in Volunteering Interested in Arts Education
Would you like to be added to our mailing list to receive monthly exhibition postcards?

Yes please! No thanks.
You will be redirected to Paypal upon clicking the 'submit' button below in order to complete payment.
Should be Empty:

Become a Fairbanks Arts Member Today