CITIZENS INTERESTED IN ARTS, INC. 
MEMBERSHIP FORM

To join Citizens Interested in Arts, Inc. 
please print this membership form and send with your check to:

Rosalie Borg
1055 Satin Leaf Street
Hollywood FL 33019
954-923-6268

Name ____________________________________

 
Address ____________________________________

 
City/State/Zip ____________________________________

 
Telephone ____________________________________

 
FAX ____________________________________

 
E-Mail ____________________________________
Birthday
(Month/Date)
  

____________________________________
Recommended
By CIA Member		  

____________________________________
Please List Participation In Other Arts Organizations  

____________________________________

Thank You!

$125.00 per membership
All contributions are tax deductible

Please make checks payable to:
Citizens Interested in Arts, Inc.
A 501©3 non-profit organization