MICAA Membership and Donation

MICAA Dues

    Benefactor                $200

    Patron                         $ 50

    Family                          $20

    Individual                   $15

    Senior (62+)              $10

    Senior Family           $15

    Student                      $10

Donation Opportunities

    Arts Scholarships      _________________

    General Fund              _________________

    In Honor of                   _________________

Total amount enclosed ________________

Make checks payable to     MICAA
                                          P.O. Box 114
                                          Monmouth, OR 97361

Name: __________________________________

Address: ________________________________

                  ________________________________

Telelphone: _________________     email: _____________________