Membership Form Print this form and mail to the AEC (3069 South Broad Street, Suite 2,Chattanooga, TN 37408) Name_________________________________________________________________ Address_______________________________________________________________ City/State/Zip_________________________________________________________ Home Phone_____________________Work Phone_________________________ E-mail________________________________________________________________ New Membership Renewal Membership Categories (please check one) Friend $35 - Receive advanced notice of programs and OPEN UP! (the AEC newsletter). Donor $50 - Receive an AEC "Members" sticker, plus all of the benefits listed above. Patron $100 - Receive an AEC Independent Film Series Membership Card, plus above benefits Associate $250 - Receive an invitation to AEC Future Focus Community Exhibit, plus above. Sponsor $500 - Receive an invitation to the AEC Conference on Southern Literature or A Reader’s Feast reception to meet guest authors, plus all benefits listed above. Benefactor - $1,000 + - Receive invitations to receptions and dinners for the AEC Conference on Southern Literature and A Reader’s Feast to meet authors, plus all benefits listed above. I am interested in remembering AEC in my will My employer’s matching gift form is enclosed. Payment Information: My check is enclosed. (Make checks payable to AEC) OR Credit Card Payment Information Visa Mastercard AmericanExpress Name (as it appears on card)_________________________________________ Account No.__________________________________________________________ Expiration Date_______________________________________________________ Signature_____________________________________________________________ Total Amount $___________________ The Arts & Education Council is a not-for-profit charitable organization exempt from taxation under section 501(c)(3) of the Internal Revenue Code. All contributions are tax deductible to the extent permitted by law.