UT TYLER FRIENDS OF THE ARTS

MEMBERSHIPS

Single- $150

Family - $250

Contribution $___________

Personal Information for Membership Roster

Name(s)______________________________________________________

Address______________________________________________________

Telephone (H)_________________________________________________

Telephone (B)_________________________________________________

Telephone (C)_________________________________________________

E-Mail_______________________________________________________

Please bill my credit card:

Credit Card Number___________________________________________

Exp Date____________________________________________________

Please Mail Application To:

Office of University Advancement

The University of Texas at Tyler

3900 University Boulevard

Tyler, TX 75799-9985