Individual $35…… Family $45
Friend $50 + …….. Patron $100
Corporate $250
All contributions are tax deductible.
The Southern Heartland Art Guild is a 501(c)(3) not-for-profit corporation.
Name: __________________________________________
Address: __________________________________________
City: ___________________ State: _____ Zip: ________
Are you an artist? ___yes ____ no
If yes, what's your medium? ____________________________
Email Address: ___________________________
Phone #____________________ ; ____________________
May we contact you to volunteer? ___yes ____no
How did you hear about us? ___________________________
Remit to: Southern Heartland Art Guild c/o Jan Jentzen
1132 Monticello Street
Covington, GA 30014