M E M B E R S H I P
A P P L I C A T I O N

YES, I want to become a member of the Sandzén Gallery.

		
  Mail this form to:     The Birger Sandzén Memorial Gallery
                         P O Box 348
                         Lindsborg, KS 67456
											 
  FAX this form to:      785.227.4170

  Visit our web site:    www.sandzen.org 
					
    New Member       Renewing Member
    

  Strom (individual)        $30
  Wallin                    $35
  Jaderborg                 $50
  Lofgren                  $100
  Brase                    $250
  Thorsén                  $500
  Milles                  $1000

	
	
    ____________________________________________
    Name
		
    ____________________________________________
    Street
		
    ____________________________________________
    City                   State          Zip
		
    ____________________________________________
    Telephone                  Work Phone
   	
    ____________________________________________
    E-mail address / Web Site
		
		
	

    Please send a gift membership to:
		
    ____________________________________________
    Name
		
    ____________________________________________
    Street
		
    ____________________________________________
    City                   State          Zip
		
    ____________________________________________
    Telephone                  Work Phone
   	
		




     Enclosed is my check payable to Sandzén Gallery  $______

    OR
		
    Please charge my membership to:
     Visa                MasterCard 
     Discover            AmEx                                $______

    _________________________________________________________________
    Credit Card Number                                Exp. Date
   
    _________________________________________________________________
    Cardholder's Signature

M E M B E R S H I P
C A T E G O R I E S

   S T R O M       -      $30
   (Individual, Senior, Student)

   W A L L I N     -      $35
   (Couple and minor children)
	   
   J A D E R B O R G      $50

 	 
   L O F G R E N   -     $100


   B R A S E       -     $250	
 

   T H O R S É N   -     $500
 

   M I L L E S     _    $1000

   All categories receive:
       Unlimited Gallery visits 
       Annual subscription to Gallery Notes newsletter
       Advance notice to all upcoming events,
       Chamber Music and Gallery Talks
       Invitations to members-only exhibition previews
             
       Gallery membership categories are named for 
			 friends and associates of Birger Sandzén.



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Support the Sandzén Gallery even more!

 Matching Funds - Check with your company 
regarding their matching gifts program.

Planned Giving - Consider Estate gifts.

For more information, visit with the Gallery Director
at 785-227-2220 or e-mail at fineart@sandzen.org.