Membership year is from March 1st until February 28th. 
Title: Mr.    Mrs.    Ms.    Mr. & Mrs.    Dr.                             Membership Renewal ? YES   NO

Name:
Address:
Parish:          Postal Code:
Telephone: (Day) (Evening)
Fax: E-mail:
Children's Names (under age 18)
Does the company you work for have a matching gifts programme? YES   NO
Name of Company:
Please send information about how I may include the Bermuda National Gallery in my will or trust: