Membership Application

	Name:  Address:  Telephone:  Home Work Fax:  Email:  City:  State:  Zip:      MEMBERSHIP CLASSIFICATION     Student - $10.00    Basic - $20.00    Organization - $35.00    Contributing - $35.00    Sustaining - $50.00    Underwriter - $100.00 - $299.00   Patron - $300.00 - $499.00    Benefactor - $1000.00 & up        DISCIPLINE: I = Interest or P = Practicing   I P - Visual Arts  I P - Music  I P - Dance I P - Literary Arts  I P - Theater        COMMITTEES: (please check one)   Public Relations Special Events  Membership Afr'Am Fest      Payment: Money Order   Check               Made payable to SEVAA   Southeastern Virginia Arts Association PO Box 1673 Norfolk, VA 23501