CPW MEMBERSHIP APPLICATION

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Name(Please Print)



Address



City, State, Zip



Home Phone



Work Phone





Membership Category:

( ) New Member

( ) Renewal

( ) Gift





Gift Recipient Name (Please Print)



Address



City, State, Zip





Amount Enclosed:



( ) Check

( ) Mastercard

( ) Visa



Credit Card Number:



Expiration Date:



Please make checks payable to CPW; MC/Visa accepted.

The Center welcomes gifts to our library and permanent print collection.  If
you would like to show your support in this way, please call the Executive 
Director, Colleen Kenyon.

Send this membership application to:  
Lawrence P. Lewis, Membership Director
The Center for Photography at Woodstock
59 Tinker Street
Woodstock, NY  12498

The Center for Photography at Woodstock, Inc., was founded in 1977 and is a 
tax-exempt charitible organization under Section 501(c)(3) of the Internal 
Revenue Code.  Your membership and gifts are tax-deductible to the extent 
allowed by law.

Tel (845) 679-9957, Fax (845) 679-6337

If you are sending CPW e-mail, please include your postal address and 
telephone/fax numbers.

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