___YES, sign me up as a member of the Sedalia Visual Art Association.

           ___INDIVIDUAL $20          ___FAMILY $35            ___ STUDENT $10

NAME________________________________________________________________

ADDRESS_________________________________________APT.#_______________

STATE______________________________________________ZIP_______________

PHONE (_____)___________________DAY (_____)____________________EVENING

MEDIA INTEREST(S)_____________________________________________________

_____________________________________________________________________

I am interested in showing in the Liberty Center Gallery       _____YES        _____NO

I am interested in________________________________________________________

_____________________________________________________________workshops.

Print out this form and mail along with you check to:

Sedalia visual Art Association
349876 Green Grove Road
Tipton, MO 65081

Make checks payable to SVAA