Washington Pavilion of Arts and Sciences Membership Form

Please complete the following form and hit "submit" at the end. For information, call (605) 367-7397 ext 2351, or e-mail rwiller@washingtonpavilion.org


	New Membership
	Renewing Membership
*Primary Adult Name
Second Adult Name
Name(s) of children or grandchildren under the age of 18

*Address
*City
*State
*Zip Code
*Phone Number
E-mail address
	Please send me the Newsletter via email



	IF NOT GIFT MEMBERSHIP, SKIP TO MEMBERSHIP TYPE SELECTION. Gift Membership?
	Mail membership to gift giver
	Mail membership to gift recipient
Name of Giver
Gift Giver Address
Gift Giver City
Gift Giver State
Gift Giver Zip code
Gift Giver Phone



Select Membership Type

	Senior (62+) or full-time student discount. Subtract $5 from Basic level price. One discount per membership. Senior/Student Discount

Additional Donation?
*Total
Please Charge My:
*Account Number
*Expiration Date


Note for me?