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Print and mail this form with your annual membership (household) of $25 to:

Print and mail this form with your annual membership (household) of $25 to:

 

Northern Lights Art Gallery

330 3rd St. NE

Mayville, ND  58257

 

 

 

 

Name(s) ______________________________________________________________

 

 

Address ______________________________________________________________

 

 

             _______________________________________________________________

 

 

Telephone _____________________________________________________________

 

 

e-mail address __________________________________________________________