After completing the form below, print and mail it to the gallery along with your check or charge card information to become a member or volunteer.

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Renew New  YOUR GIFT IS TAX-DEDUCTABLE 
Single   $35   
Family   $50   
Student   $10    		Friend  $100 - $249   
Sustainer  $250 - $499   
Patron  $500 - $999   		 Benefactor $1000 + 
 
Gift  $
 
NAME(S):  
ADDRESS:  
CITY:  

   STATE  /  ZIP

PHONE:   EMAIL:  
ARTIST MEMBERS: 1st Artist Name:  
Medium:   		2nd Artist Name:  
Medium:  
Are you interested in Volunteer Opportunities?     YES  
Add Virginia Museum Partner Membership (optional): Single $20   Family $30  
TCAG $ + VMFA Partner $ = TOTAL ENCLOSED:  $
Please list names & birth years of VMFA FAMILY MEMBERS under 21:
 
PAYMENT METHOD:     CHECK: "This Century Art Gallery" VISA Mastercard
Charge ACCOUNT NUMBER:
  		EXP DATE:
 / 
Name on Account: Signature:
 
For TCAG Use only:
Renewal Due Date:     
 		 Date Received:     
 		 Amount:          
 		 Check / Charge / Cash
 		 New Renewal Date: