Nuvisions for Disabled Artists, Inc.

Membership Application

Information

Membership Catagories (chech one)

Name:

____ Exhibiting ($25)

Address:

____ Individual ($25)

City:

____ Family ($35)

State:

____ Sustaining ($50)

Zip:

____ Patron ($500)

Phone:

____ Corporate ($1,000)

Make checks payable to: Nuvisions, c/o Rose Marcus, 1319 Magee St., Phila., Pa 19111

(If Exhibiting Membership is chosen please complete area below.)

Education:

 

 

 

 

 

Exhibition Experience:

 

 

 

 

 

 

 

back to home page ___________ (Print out this form if you wish to join and mail to Nuvisions)