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MISSISSIPPI ALLIANCE FOR ARTS EDUCATION
Membership Form

We invite you to join us
 in putting the power of the arts to work for Mississippi and every Mississippi student.

Name___________________________________________Date_________________

Occupation or Title_____________________________________________________

Organization (if applicable)_______________________________________________

Business Address ______________________________________________________

City, State, Zip________________________________________________________

Home Address________________________________________________________

City, State, Zip________________________________________________________

Daytime Phone______________________Home Phone________________________

E-Mail Address_____________________Fax Number_________________________

A current e-mail address is important. Most communication is done electronically including our MAAE newsletter.
________________________________________________________________________

Membership:

________Student $10     ________Individual $30     ________Retired $20 

________Cultural Institution/Organization $75     ________School District $100 

________Patron $100      _______Benefactor $250      _______Lifetime $450

_______Grand Benefactor $1,000
(includes lifetime membership)

(Your dues and gifts are tax deductible.)

Please mail this form with your check to:

Mississippi Alliance for Arts Education
101 Carrie Road
Hattiesburg, Mississippi  39402

e-mail: Lola.Norris@usm.edu

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