After completing the form below, print and mail it to the gallery along with your check or charge card information to become a member or volunteer.


     
219 North Boundary  *  Box 388
Williamsburg, Virginia 23187

A Virginia Museum of Fine Arts Partner
www.thiscenturyartgallery.org
Renew New  YOUR GIFT IS TAX-DEDUCTABLE 
Single   $35    
Family   $50    
Student   $10    		 Friend  $100 - $249    
Sustainer  $250 - $499    
Patron  $500 - $999    		 Benefactor $1000 ++
 
Gift  $ 
 
NAME(S):  
STREET:  
CITY/ZIP:  
PHONE:   EMAIL:  
ARTIST MEMBERS: 1st Artist Name:  
Medium:  		 2nd Artist Name:  
Medium:  
Are you interested in Volunteer Opportunities?    YES  
Add Virginia Museum Partner Membership (optional): Single $20   Family $30  
TCAG + VMFA Partner = TOTAL ENCLOSED     $ 
Please list names & birth years of VMFA FAMILY MEMBERS under 21:
 
PAYMENT METHOD: CHECK: "This Century Art Gallery" VISA Mastercard
Charge ACCOUNT NUMBER:   EXP DATE:  
Name on Account: Signature:
 
For TCAG Use only:
Renewal Due Date:     
 		 Date Received:      Amount:           Check / Charge / Cash New Renewal Date: