PCAC Membership/Interest Form

Your name (required): ______________________________________________________________________________________

E-mail address (required): ___________________________________________________________________________________

Organization or affiliation: ___________________________________________________________________________________

Your title or relationship to that organization: _________________________________________________________________

Mailing address: ____________________________________________________________________________________________

City: _______________________________________________________________________________________________________

State: __________________ Zip: __________________

Phone number(s) — list as many phone numbers as you wish. Please specify home, office, fax, etc.:

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Please check all that apply:

_____ Please add me to your mailing list (or update my listing) so I can receive information about concerts and other PCAC events or opportunities.

_____ I wish to become a Member of PCAC:

         _____ Individual ($35)

         _____ Family ($35)

         _____ Non-profit Arts Organization (free)

         _____ Business ($50)

_____ I want to make an additional donation to PCAC of $_______________. All amounts are welcome!

Membership dues and all additional contributions are tax-deductible charitable donations. If you would like to designate your tax-deductible donation to a specific program (such as Arts in the Schools, Young Artist Individual Achievement Awards, the Phyllis Wentworth Memorial Fund, etc.), please specify that designation here:

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If you are joining as a member and/or making a donation, please send your check, made payable to "Pleasanton Cultural Arts Council" or "PCAC" to our mailing address: Pleasanton Cultural Arts Council, P.O. Box 1298, Pleasanton, CA 94566.

_____ I want to learn more about volunteering to work on PCAC activities and programs.

_____ I would like to explore possibilities for cooperation or partnership between my business/organization and PCAC.

_____ I have the following questions or comments:

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