$ 15.00 Senior or Students		$ 500-999 Patron
	$ 25.00 Individuals		$ 1,000+ Benefactor
	$ 40.00 Family (3 or more)		$ 5,000+ Corporate Benefactor
	$ 100-499 Sponsor

First Name		Last Name
Address		City
State		Zip
Country		Home Phone
E-mail		Work Phone
I am a fine artist		I am interested in the volunteer program

To register, please print the registration form, complete with your information and send it to:

250 W. FIRST ST. #100 - CLAREMONT, CA 91711 THE VILLAGE PLAZA

Please make your check payable to: Latino Art Museum