Membership

Application

Mr___Mrs___Ms___

Name ____________________________________

Address __________________________________

City ____________________________________

State ______________________zip ____________

Phone (Residence) __________________________

Phone (Business) ___________________________

Membership Category

Individual $40

Dual/Family $60

Associate $100

Student/Educator/Senior $25

Director's Circle $250 $500 Other_

Business Member $_____ Business Partner $______

____ Enclosed is my check made payable to JMoCA

Charge to __Visa _MasterCard _ American Express

Card no. _________________________________

Expiration date __________________

Signature _________________________________

Please mail to: The Jacksonville Museum of Contemporary Art
Membership Office
4160 Boulevard Center Drive
Jacksonville, FL 32207

Benefits of Membership