Name: ___________________________________________________________________________________
Organization: ____________________________________________________________________________
Address: ________________________________________________________________________________
City: ____________________________________________________, CA Zipcode: __________________
Phone: ______________________________________ Fax: _____________________________________
Contact E-mail: __________________________________________________________________________
Organization's Website: ___________________________________________________________________
CEO/President: ___________________________________________________________________________
Membership Dues:
Organization:
Budgets $1 million and above ................. $500 Budgets from $500,000 to $1 million.............. $250
Budgets from $250,000 to $499,999 ........... $175 Budgets from $100,000 to $249,999................ $100
Budgets under $100,000 ............................ $50
Your organization's budget: $ ________________ Amount Paid: $ ____________
Individual:
Benefactor ................ $250 Advisor ................ $100 Advocate............. $50
Friend ....................... $25 Student ................ $15
Amount Paid: $ ____________
Your membership is CAA's only source of income.
Please consider an additional contribution: $ ______________
Total Amount Paid: $ ____________
Additional Information:
My elected officials are: Assemblymember: ______________________Senator:________________________
Congressmember: _________________________I know my elected officials personally ________
Call on me to give testimony? ________I am interested in Arts Advocacy workshops? ________
I am interested in serving on the CAA Board of Directors or CAA Advisory Committee? _______________
Please print this form and mail with a check payable to:
California Arts Advocates
1663 Mission St. Ste 525
San Francisco, CA 94103
Ph: 415-430-1140
Fax: 415-430-1145