 | DWC MEMBERSHIP FORM
Name: ____________________________________
Address: ____________________________________
City, ST, Zip: ____________________________________
Phone: ____________________________________
E-mail: ____________________________________
Please check the membership level of your choice:
_____ Individual Membership ($35)*
_____ Family Membership ($60)*
_____ Friend ($75-$99, enter amount here: ________)
_____ Patron ($100-$199, enter amount here: ________)**
_____ Maestro ($200-$399, enter amount here: ________)**
_____ Muse ($400 & up, enter amount here: ________)**
* Current YMCA of Greater Syracuse members may join at these levels at a $15 discount.
** Patron, Maestro and Muse members may select one person to receive a scholarship
to a DWC creative writing course. The director will contact you to help with
your selection.
+ Each Muse member is recognized as a co-sponsor for one visiting author reading.
The director will contact you to help with your sponsorship selection. Muse members
may co-sponsor an additional DWC reading for each $150 over the initial $400 gift
(so a $550 Muse Membership would allow the member to co-sponsor two readings,
$700 would co-sponsor three readings, etc.).
Please return this form with payment to:
YMCA of Greater Syracuse
Attn: Phil Memmer
340 Montgomery St.
Syracuse, NY 13202
Make checks payable to YMCA, or use your credit card:
Card Type (circle): Visa, MasterCard, Discover, Am. Ex.
Card Number: _________________________
Expiration Date: ____________
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