Print and Mail to:
Academy of Western Artists
P.O. Box 35
Gene Autry, OK 73436
Basic Membership   $  35.00
Family/Trio Membership   75.00
Band/Group Membership   140.00
Listing on Open Website (Hyperlink to your website)                                    Add 15.00
Access to Secure Website & Hyperlink to your website
(Username & Password for access)                  
Add 50.00
Subscription to Rope Burns                                                                                  Add 15.00
Subscription to CC&W Publication                                                                      Add 20.00
Building Fund donation    
General fund donation    

Subtotal

   

Total Enclosed

   

NAME:_____________________________________________________________________________________________________


ADDRESS:__________________________________________________________________________________________________



CITY/STATE/ZIP_______________________________________________________________________________________________


PHONE (Work)________________________________HOME________________________________CELL_______________________


E-Mail Address:_______________________________________________________________________________________________


WebSite:
http://www.
______________________________________________________

Company/ Artist Name:
_____________________________________________________________

Please List what you do_______________________________________

 

Method of Payment
______Check (Personal - Business) US Funds Only
______Money Order- US Funds
______Credit Card
______Visa
______MC

Card Number
_______-________-________-________

Expiration Date

_____/______

Signature
__________________________________