Please print off this form, complete and send to:
Michael Bergt, PO Box 30766, Santa Fe, NM 87592-0766, USA

Application for Membership - USA

Please enrol me as a member of The Society of Tempera Painters

       General Member $35.00
       Patron/Contributor $75 and up.

Please make checks payable to Society of Tempera Painters
The Society is a New Mexico, non profit corporation. (505) 473-9654

Last Name.........................................................................

First Name(s).....................................................................

Organisation......................................................................

Address...........................................................................

City..............................................................................

State.............................................................................

Zip...............................................................................

Country...........................................................................

Telephone.........................................................................

E-mail............................................................................

Fax...............................................................................

How long have you been using egg tempera?

      1 - 5 years
      5 - 10 years
      over 10 years

 What is your primary medium?

  Egg Tempera      Oil
  Acrylic                 Watercolor
  Other : please specify

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Do you wish your contact details
to be included in the directory?

  Yes
  No

 To gain a better understanding of one another,
in 30 words or less, please explain either
your work, interest or connection with egg tempera
on the reverse of this form or on a separate sheet of paper.