The Adams County Arts Council
Membership Form (for calendar year 2022) Date: _________________
Name: _____________________________ Phone: __________________(land) __________________(cell)
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:
____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 firstname.lastname@example.org via PayPal.
Adams County Arts Council