Friends of the Gallery Membership Form

______ Enclosed is my donation of $200.00 ( Checks payable to Art in the Loft )

Please charge my credit card:     ____ Visa      ____ MasterCard     ____ Discover
 

Name:_______________________________________________________________________
         *please print your name as you would like to be recognized


Address: _____________________________________________________________________


City: ______________________________________    State: ________      Zip: _____________
 

Credit Card #  ________________________________________________________________

Expiration Date:  ____________________________

Card Holder Signature:  __________________________________________________________

Date:  ___________________________________________

Mail To:
Art in the Loft
109 N. Second Avenue
Suite 300
Alpena, MI.  49707

Thank you for your support!