MEMBERSHIP FORM
                                    Yes, I want to become a member of Gallery at the VAULT

  Please consider one of the categories:                         Membership benefits:
  ____Individual      $20.00                                                        Discounts in the gift shop   
  ____Family (3+)   $50.00                                                         Reduced fees for lectures and workshops
  ____Student         $10.00                                                         Support of student shows 
  ____Senior (65+) $10.00                                                          Invitaions to gallery events
  ____Supporter     $50.00 -   $249.00                                       Supporting culture in downtown Springfield 
  ____Collector       $250.00 - $499.00
  ____Curator         $500.00 + 


  NAME_________________________________________________________________________________

  ADDRESS______________________________________________________________________________

  TOWN ________________________________________________________________________________

  STATE_______________________________ZIP__________________PHONE_____________________

 
  E-MAIL________________________________________________________________________________

  CHECK ENCLOSED FOR _____________________________________
  Payable to:  
Gallery at the VAULT
68 Main Street
Springfield, VT. 05156
Thank You!