Individual Membership Form  Send this form with your check to:

Modesto Art Museum, 404 Patrick Lane, Modesto, CA 95350

Please Print Carefully

First Name _________________ Last Name ____________________

Address _______________________

City _________________________ State ____ Zip  _____________

Email Address ___________________________________________

Phone: Area Code _________   Number ______________________

Type of Membership (Circle One)   One Year        Two Years

Membership is from $5 to $75 per person per year,

based on what you would like to offer.

Amount enclosed for membership:  $         

Additional gift to the museum: $                    (The gift is tax deductible.)

Total enclosed: $                Check made out to Modesto Art Museum.

Thank You!