1

First and Last Name

 *

First and Last Name

2

Email Address

 *

Email Address

3

Physical Address

 *

Physical Address

4

Which Membership Program are you interested in?

Which Membership Program are you interested in?

Creative/Artists ($25 per year)

Art Patron - Individual ($50 per year)

Art Patron - Family/Household ($75 per year)

5

My medium is...

My medium is...

Paint - Acrylic or Oil

Watercolor

Photography

Sketch

Glass

Portraits

Other (please specify) If other, type text here.

6

Website/Social Media Handles

 *

Website/Social Media Handles

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