I, the undersigned (followed by Last and first names printed) ________________________________________________________________
Company (if corporate adhesion) _______________________________________
Title in company _______________________________________________________
Zip, City, Canton/State _______________________________________________
Day phone _______________________________________________________________
Wish to adhere to the Galerie Quint-Essences in the quality of an enterprise c or individual c (please check the correct answer).
m As a guest from time to time - you will receive a free invitation to openings by e-mail only
m As a Member - you will receive invitations by postal mail and the "Quint-Essential News" 4 times a year - 120 CHF / year
m Friend of the Gallery - all of the above as well as free entry to three paying activities per year of your choice fora value of not more than the subscription as a Friend of 250 CHF / year
m Friend of the Arts - all that a Friend of the Gallery obtains but you also sponsor an event during the year. We shall be happy to provide you with a list of activities from which to choose, such as conference speakers, performing arts on the roster, an artist's project, etc.) - 500 CHF / year.
Subscription signed at (city) _______________________________ date_____________
Payment by m Mandat postal m BVR, made out to Harriette Laurent (request bank information) m or in cash
Received on (date)_______________________
by the representative of the Gallery, (initials then signature)