Membership Application
We now accept Visa and MasterCard
| First Name: |
Last Name: |
| Address: |
| City, State (or Province): |
| Zip (or Postal) Code: |
| Country: |
| Day Phone: |
| Evening
Phone: |
| Email Address: |
| Where did you
learn about the NAN Web site? |
| Check One: |
| ______ |
Friend of NAN |
Donation of $25.00 or more |
| ______ |
Associate Member |
$25.00 |
| ______ |
Graduate Member |
$35.00 |
| ______ |
Life Member |
$500.00 |
|
Payment Method:
| _______ |
Check |
| _______ |
MasterCard |
| _______ |
Visa |
|
Number: ______________________________ |
|
Expiration Date: ________________________________ |
|
Signature:______________________________________ |
|
Payments must be in US dollars drawn on a US bank, or in
international postal money orders in US dollars.
Mail the completed application form and your payment to:
National Academy of Needlearts
Dawn Donnelly
52806 Stags Ridge
Macomb MI 48042
Credit card payments may be faxed to 586-677-5829.
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