Membership Form

____ I want to join BAVC.

Name:	____________________________________
Address:	____________________________________
City/State/Zip:	____________________________________
Day Phone:	____________________________________
Evening Phone:	____________________________________
Email Address:	____________________________________

Please indicate type of membership and payment:

Individual PIXEL

____Check payable to BAVC for $55 is enclosed

Or, please charge $55 to my

____Mastercard, ____Visa, or ____American Express

Account #:	____________________________________
3-digit code:	____ (back of card)
Expiration Date:	____________________________________
Name as it appears on card (if different from above):	____________________________________

Individual MEGAPIXEL

____Check payable to BAVC for $100 is enclosed

Or, please charge $100 to my

____Mastercard, ____Visa, or ____American Express

Account #:	____________________________________
3-digit code:	____ (back of card)
Expiration Date:	____________________________________
Name as it appears on card (if different from above):	____________________________________

Individual GIGAPIXEL

____Check payable to BAVC for $250 is enclosed

Or, please charge $250 to my

____Mastercard, ____Visa, or ____American Express

Account #:	____________________________________
3-digit code:	____ (back of card)
Expiration Date:	____________________________________
Name as it appears on card (if different from above):	____________________________________