___ New ___ Renewal

Please complete the following information, writing names as you want them to appear on mailings and in publications:

__ Dr. __ Mr. __ Mrs. __ Ms. __ Miss

Name(s): ____________________________________

Street: ______________________________________

City: ______________ State: _____ Zip: _________

Telephone: __________________________________

e-mail: ______________________________________

Please check your selected membership category:

___ President’s Circle $500+
___ Benefactor $250-$499
___ Associate $200-$249
___ Patron $100-$199
___ Contributor $50-$99
___ Family $35
___ Individual $20
___ Senior Citizen $10
___ Student $10

Please return, with check payable to Nora Eccles Harrison Museum of Art, to:

Nora Eccles Harrison Museum of Art
Attn: Membership
Utah State University
650 North 1100 East
Logan, UT 84322-4020

The cost of Museum membership is tax deductible, if you itemize, and may be taken as credit on federal and state tax. Your official receipt from the University Development Office will indicate the amount of your charitable gift. Recognition is also given to payroll deduction, deferred, or special gifts.