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

           ___INDIVIDUAL $15          ___FAMILY $25            ___ 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
1011 McVey Road
Sedalia, MO 65301

Make checks payable to SVAA