Please print out and complete this membership form
and return it with your payment to:

Arts Council - Windsor & Region (ACWR)
1942 Wyandotte Street East, Windsor, Ontario N8Y 1E4
Phone: (519) 252-6855 Fax (519) 252-6553 E-mail: acwr@mnsi.net

Please accept my application for membership. I have checked the appropriate box below.

Individual - $30
Family - $45
Senior - $20
Student - $20
Non-Profit - $45
Business - $125
LIFETIME - $250

New Membership Rates (above) effective March 29, 2005

Name________________________________

Organization_____________________________

Address___________________________________________________

City____________, Province___________________ Postal Code____________________

Phone_____________ Fax____________ E-mail________________

In addition to my membership, I would also like to make a tax deductible donation of $ _________ to the Arts Council - Windsor & Region.

I do not wish to obtain a membership at this time but would like to make a tax deductible donation of $ __________ to the Arts Council - Windsor & Region.

ARTS COUNCIL - WINDSOR & REGION THANKS YOU FOR YOUR SUPPORT

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