Please print this page, complete, and return this application:

Leave at the Sandpiper Gallery with check for the appropriate level of membership

OR

Mail with check to P.O. Box 1163, Polson, MT 59860-1163

ATTN:  MEMBERSHIP COMMITTEE & TREASURER

__________________________________________________________________________________

Attn:  Membership Committee & Treasurer

YES, I WOULD LIKE TO BE A MEMBER OF THE SANDPIPER GALLERY!

NAME _________________________________________________________________________

ADDRESS ______________________________________________________________________

PHONE (H)  ___________________________  (W) _________________________________

EMAIL ___________________________________________________

I would prefer to be a(n):  _____ACTIVE   _____ASSOCIATE   _____PATRON

                        _____ STUDENT (Local HS/College attending: __________________________________ )

_____  I am an artist.  I usually work in (media) ____________________________________________

_____  I enjoy art and want to encourage the Arts.