Friends Membership Application Form

To make your gift by mail, print out this Membership Application and make your gift by credit card or check. Mail completed form to Friends of the School of Music, P.O. Box 7405, Louisville, KY 40257-0405.

Name:_______________________________________________________________________

Email Address:_________________________________________________________

Phone: ______________________________________________________________

This is a joint gift with (Name):____________________________________________________

Street:_______________________________________________________________________

City:____________________________ State:______________ Zip:_____________

Annual dues: Circle one.

• Individual $35
• Family $50
• Full-time student $10

Choose the amount of your gift to G0111 (Friends account # at the University):

• School of Music Society ($5,000)
• Dean’s Circle ($2,500)
• Sustainer ($1,000)
• Benefactor ($500)
• Sponsor ($250)
• Patron ($100)
• Other____________________

I am paying by: Choose one.

• Check amount_____________________
• Charge my credit card this amount___________________
• Visa #____________________________________ Exp Date:_______________
• Mastercard#____________________________________Exp. Date:_________________