Jefferson County Art Guild
Membership Application

Membership Dues for Participating Artist $35.00/yr

	Name:_________________________________________

	Address:________________________________________

	City:_____________________________Zip:___________

	Phone:__________________________________________

	E-Mail:_________________________________________

Make check or money order payable to Jefferson County Art Guild and mail to :

	Jill Thompson
	17308 Thunder Creek Rd
	Wildwood,  MO 63025
	Phone:  314-973-3764