BAC Membership Form

Name (Please Print)__________________________________________________

Address___________________________________________________________

City______________________________________________________________

State________________________

Zip_________________________

Phone (W)______________________________________

Phone (H)_______________________________________

Email address____________________________________

Category____________________

Amount_________

Please make checks payable to:

Barrett Art Center
55 Noxon Street
Poughkeepsie, NY 12601

Or pay by VISA, Mastercard or Ameriacn Express:

Cardholder's Name
(Please Print)_____________________________________________________________________

Signature_________________________________________________________________________

VISA______________________________________________Card #_________________________

M/C______________________________________________Card #_________________________

Expires______/______/______

Print form and mail to
Barret Art Center, 55 Noxon St., Poughkeepsie, NY 12601