Embrace Art - Reach out for Peace
line decor
  HOME :: MISSION :: MEMBERSHIP :: PEOPLE :: HISTORY :: PROJECTS :: FEEDBACK :: CONTACT
line decor

GHtA Inc.


Print and fill in this form or download as a pdf-file		 GHtA Inc. Logo

Membership Application (please print clearly)

Date:

  

 

Personal Information
Full Name:      
Last First M.I.
Address:    
Street Address Apartment/Unit #
       
  City State ZIP Code
Home Phone: (   ) Alternate Phone: (   )
E-mail Address:  

 

Membership fees are: Student $30.00 (per annum)
  Individual $60.00 (per annum)
  Family $90.00 (per annum)

 

Total Amount enclosed: $______________________

Please make checks payable to GHtA Inc. Mail this form and check to:

Wini King
Attn: GHtA Inc.
9736 East Apache Trail # 13
Mesa, AZ 85207

 

Contributions to GHtA Inc. are tax deductible. Tax exempt status: #74-3149448.