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Individual (18+) $30
Artist / Senior (60+) / Student $20
Family $50
Business $100
Associate $250–$499
Advocate $500–$999
Please identify your membership type:
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Student
Senior
Artist
Please accept my contribution of $:
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Name of second cardholder:
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Name of third cardholder:
*
Name of fourth cardholder
*
Benefactor $1000–$2499
Leader $2500–4999
Visionary $5000+
Please accept my contribution of $:
*
Please consider making a donation to Oakville Galleries. A tax receipt will be issued for donations over $10.
Donation amount ($)
New membership
Renewal
First Name
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Last Name
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Address
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City
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Province
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Postal Code
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Telephone
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Email Address
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For recognition purposes please list my name as:
I wish to remain anonymous
Total:
$0.00
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Name on Card
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Credit Card Number
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Credit Card Type
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American Express
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Expiration Date (mm/yy)
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Security Code
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