Mail to: Or Fax to:
Texas Nonprofit Theatres
1300 Gendy Street
Fort Worth TX 76107		 (817) 731-2239
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-Please type or print legibly-

Industry Membership Form

Name of Business:

_____________________________________________________________________________

Mailing Address : ______________________________________________________________

_____________________________________________________________________________

City : ___________________________ State (abbreviation) : ______ Zip : _________________

Contact Person : _______________________________________________________________

Title of the Contact Person : ______________________________________________________

Business Office Number: ( ____) ____ - ________

Fax Number : (____ ) ____ - ________

E-mail : ___________________________________

Website : ___________________________________

- Check only one box -
For Profit Theatre
Theatre Related Business
Type of Business or service_______________________________________
-Page 1-
TNT Industry Memberships
 Industry Membership
$100.00
 *Industry Patron
$250.00
 *Industry Contributor
$500.00
*Memberships at these levels will be listed in the newsletter and the annual Texas Nonprofit Theatres Directory unless the member prefers to remain anonymous.


___ Check or money order enclosed
___ MasterCard
___ VISA
___ American Express
- Make checks payable to TNT -

Card # ________________________________________________________

Exp Date ____/____

V-code (V-Code: the last 3 digits on the signature line on the back of credit card) _______________

Signature ______________________________________________________


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: