Cultural  Center  for  the  Arts  &  Crafts
P.O.  Box  1000,  Crystal  Springs,  MS   39059
Jennie  Lou  Mintz,  Executive  Director:   601-892-7527
e-mail  the  CCAC  at:  robertmintz@bellsouth.net


MEMBERSHIP / SPONSOR  FORM -- January  2008  -  December  2008


______Single  $10.00   ______Couples  $15.00   ______Business  $20.00 (includes 4 people)


Name(s):____________________________________________________________________


Business Name:______________________________________________________________


Address:____________________________________________________________________


Telephone Number:__________________________________________________________


E-mail:_____________________________________________________________________



_________ I do not wish to be a member ;  however I would like to make a donation:



Platinum - $ 500.00_______ Gold - $ 250.00_______ Silver - $ 100.00_______ Other_______