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Please
print this page, complete the form, and mail the form along
with your check to:
Coutts Memorial Museum of Art
110 N. Main
El Dorado, KS 67042-0001
_____ Yes, I want to support this unique and valuable asset.
(Your gift is tax deductible!)
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Name:_________________________________________Telephone:______________________
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Address:_______________________________________________________________________
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| City:___________________________________________State:_____Zip:__________________ |
E-mail:________________________________________________________________________
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Membership
Level: Membership
gift prints for memberships of $50 or above only, while supply
lasts. One print per family.
_____Single, $25 |
_____Patron, $50 |
_____ Benefactor, $500 & above |
_____Couple, $50 |
_____Underwriter, $100 |
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Consider
purchasing a Gift Membership for that hard-to-buy-for friend
or relative. We will send them a gift certificate stating
you have made this gift membership in their name and also
send them their FREE gift print. What a great Christmas or
anytime gift!
Please
send a Gift Membership to:
Name:_________________________________________Telephone:______________________
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Address:_______________________________________________________________________
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| City:___________________________________________State:_____Zip:__________________ |
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