Membership Form

Outpost Membership & Support Form

You can either print this form out and mail to Outpost with a check or credit card number 
OR make a donation and/or buy a membership ON LINE. 
Secure online payment now available via Paypal. Click button and follow instructions.  
Please click on “add special instructions to the seller” and indicate in the box how much 
of your contribution should go towards membership and/or how much for general donation.


I’D LIKE TO MAKE A SPECIAL TAX-DEDUCTIBLE CONTRIBUTION 
TO OUTPOST’S EDUCATION PROGRAM IN MEMORY OF TIM DE YOUNG

Amount enclosed:  $________________________________________


I’D LIKE TO MAKE A SPECIAL CONTRIBUTION TO OUTPOST’S 2010 ANNUAL CAMPAIGN  
IN SUPPORT OF THE UNIQUE PROGRAMS OF THE OUTPOST PERFORMANCE SPACE

___  $1,000  ___  $500 ___  $250 ___  other $______

Amount enclosed:  $________________________________________


I WANT TO BECOME AN OUTPOST MEMBER IN ORDER TO SUPPORT OUTPOST PROGRAMS 
AND RECEIVE VALUABLE MEMBER BENEFITS

__ $25	Artist/Senior (1 Discount to all Outpost Events)

__ $45	General (1 Discount to all Outpost Events)

__ $75	Supporting (2 Discounts to all Outpost Events)

__ $125	Sustaining (3 Discounts to all Outpost Events)

__ $300	Patron (1 Free Pass plus 1 Discount to qualifying events. 3 Discounts to events where pass not valid)

__ $575	Benefactor (2 Free Passes plus 2 Discounts to qualifying events. 4 Discounts to events where pass not valid)

	All Members' children under 12 receive 1/2 price admission

	All Students receive member discount with valid student ID.

I would like a subscription to the Outpost's newsletter
__ $10	mailed for Fall, Spring, and Summer seasons

I WOULD LOVE MORE INFORMATION ABOUT:

__ Outpost Productions' CORPORATE SPONSORSHIP & ADVERTISING opportunities for businesses

__ I'm interested in learning more about becoming an OUTPOST VOLUNTEER

Name: _____________________________________________________________________

Address:____________________________________________________________________

City______________________________________    State_______    Zip______________

Email: _________________________________	Phone #: ________________________

Date:__________________________________

Amount Enclosed: $______________________

Please make checks payable to Outpost Productions, Inc. – a 501 (c) 3 Non-profit Corporation 
...OR...
Credit Card# (MC or Visa only):_________________________________          
Exp date ___/ ___/___
Signature:_____________________________________________

Outpost Membership & Support Form

Mail to: Outpost at PO Box 4543, Albuquerque, NM 87196