Membership Form

____ My organization wants to join BAVC.

Name:	____________________________________
Organization:	____________________________________
Address:	____________________________________
City/State/Zip:	____________________________________
Day Phone:	____________________________________
Office Phone:	____________________________________
Email Address:	____________________________________

Please indicate type of membership and payment:

Not-For-Profit PIXEL

____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):	____________________________________

Corporate PIXEL

____Check payable to BAVC for $500 is enclosed

Or, please charge $500 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):	____________________________________

Corporate MEGAPIXEL

____Check payable to BAVC for $1,000 is enclosed

Or, please charge $1,000 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):	____________________________________

Corporate GIGAPIXEL

____Check payable to BAVC for $2,500 is enclosed

Or, please charge $2,500 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):	____________________________________