The Adams County Arts Council

Membership Form (for calendar year 2022)        Date:    _________________

 Name: _____________________________            Phone: __________________(land)  __________________(cell)

 Address: ____________________________________________________
Email: ______________________________________________________
Family: $20.00 _____ / Individual: $15.00 _____/ Student: $10.00 _____
Membership total: $ _______
Building fund donation? (amount) $_______  Additional donation? (amount) $ __________ 
Total amount: $ ____________  (tax deductible)  paid by: check             cash    or PayPal
If family membership, list all members:____________________________________________
Please indicate your area(s) of interest:
____Painting/Drawing                                              _____Quilting/Sewing
____Ceramics                                                            _____Writing/Poetry
____Theater                                                              _____Photography
____Sculpture/Woodworking                                  _____Administrative
____Music                                                                  _____Support
____Dance                                                                 _____Needlework                                                                       Other interests?______________________________________

  Please give as much information as possible so we can be a team to develop the Arts
and discover artists in Adams County.

 Return to: Adams County Arts Council, P.O. Box 38, West Union, Ohio 45693

Or Pay/Donate at via PayPal.