First Name:
Last Name:
Address:
City:		State:
Zip Code:		Country:
Phone Number:
Phone Number:
Amount:
Check enclosed:	yes
Credit Card information: Master Card Visa Card #: Exp Date Code (3 digit security code)
Please make payable in US funds. Thank You. Patrons of Exceptional Artists, Inc. was founded in 1997 in Miami, Florida as a 501(c)(3) foundation. All contributions are tax deductible to the extent allowed by law.