SF Camerawork | MEMBERSHIP FORM

SF Camerawork Membership Form

Print and mail or FAX to:
SF Camerawork
657 Mission Street, 2nd Floor
San Francisco, CA 94105
FAX: 415.512.7109

Name:

Address:

City/State/Zip/Country:

Phone (day): Phone (eve):

E-mail:

Please check one:

___ New
___ Renewal
___ Gift

Please choose one category: (All amounts are in U.S. dollars)

___ Platinum - $5,000 (receive Ruth Bernhard print)
___ Gold - $2,500 (choose 2 Patron Level prints or 1 Patron Level and 4 Collector Level prints)
___ Patron - $1,250 (choose 1 Patron Level print or 4 Collector Level prints)
___ Benefactor - $650 (choose 2 Collector level prints)
___ Collector - $350 (choose 1 print)
___ Sponsor - $200 (receive Katsushige Nakahashi's work)
___ Household - $85
___ Subscribing Member - $50
___ Student/Senior - $30 (include photocopy of current ID)
___ International - $40

Indicate your print selection(s:)
(for those joining at Collector level and above)

1. _______________________________________
2. _______________________________________
3. _______________________________________
4. _______________________________________

Add $25 for shipping and handling of print(s) $_______

I would like to make an additional contribution of $_______
to support SF Camerawork's programs.

TOTAL AMOUNT ENCLOSED: $_______

___Check Enclosed

Please charge my: ___ Master Card ___ Visa Card

Account number: _____-______-_____-____Exp: ___/___
Name on card: ________________________
Signature:____________________________
CVV (Security Code): _________________

Return to Membership Page

Name:
Address:
City/State/Zip/Country:
Phone (day):	Phone (eve):
E-mail:
Please check one: ___ New ___ Renewal ___ Gift Please choose one category: (All amounts are in U.S. dollars) ___ Platinum - $5,000 (receive Ruth Bernhard print) ___ Gold - $2,500 (choose 2 Patron Level prints or 1 Patron Level and 4 Collector Level prints) ___ Patron - $1,250 (choose 1 Patron Level print or 4 Collector Level prints) ___ Benefactor - $650 (choose 2 Collector level prints) ___ Collector - $350 (choose 1 print) ___ Sponsor - $200 (receive Katsushige Nakahashi's work) ___ Household - $85 ___ Subscribing Member - $50 ___ Student/Senior - $30 (include photocopy of current ID) ___ International - $40 Indicate your print selection(s:) (for those joining at Collector level and above) 1. _______________________________________ 2. _______________________________________ 3. _______________________________________ 4. _______________________________________ Add $25 for shipping and handling of print(s) $_______ I would like to make an additional contribution of $_______ to support SF Camerawork's programs. TOTAL AMOUNT ENCLOSED: $_______ ___Check Enclosed Please charge my: ___ Master Card ___ Visa Card Account number: _____-______-_____-____Exp: ___/___ Name on card: ________________________ Signature:____________________________ CVV (Security Code): _________________