Mail to: Or Fax to:
Texas Nonprofit Theatres
1300 Gendy Street
Fort Worth TX 76107		 (817) 731-2239
(MC, VISA OR AMEX required)
-Please type or print legibly-
Individual Membership Form

Name : _____________________________________________________________________

Organization (optional) : _______________________________________________________

Mailing Address: _____________________________________________________________

City : _______________________ State (abbreviation) : ______ Zip : __________________

Home Phone ( ____) ____ - ________ Business Phone (____ ) ____ - ________

E-mail : ____________________________

TNT Individual Memberships
 Youth (18 or under)
$7.00
 Student (College)
$15.00
 Regular
$25.00
 Sustaining    
$50.00
 *Texan    
$100.00 and up

*Memberships at these levels will be listed in the quarterly newsletter and the annual Texas Nonprofit Theatres Directory unless the member prefers to remain anonymous.

___ Check or money order enclosed ___ MasterCard ___ VISA ____American Express

Card # _____________________________Exp Date ___/____ V code (last three digits on the signature line on the back of your card) ____

Signature ___________________Name that appears on the card ____________________

- Make checks payable to TNT -
Texas Nonprofit Theatres, Inc. is a not-for-profit corporation under Section 501 (c)3 of the Internal Revenue Code.
Contributions to TNT are tax deductible.

For Office Use Only
Amount Paid: Rec'd Paid: Check #: Payment Date: