ARTISTS IN ACTION MEMBERSHIP APPLICATION FORM
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PLEASE PRINT OUT THIS FORM, FILL IN ALL THE DETAILS AND MAIL TO THE ADDRESS AT THE BOTTOM OF THIS FORM.
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Name: ______________________________ email address: ________________________ Address: ____________________________ City ______________________ State ________ Zip ___________ Phone No. Day (_____) ________________ Eve (_____) ______________________ Art Website (if any): ________________________________ Type of medium (oil, watercolor, ceramic, digital photography, etc): _________________________________________________________________ Subject (landscape, portraits, abstract, floral, whimsy, etc.): _________________________________________________________________ Please check here if you do NOT want to be listed on the Artists in Action website: ___ (Home addresses will not be made public.) Membership fee is for one year. My check is enclosed: $25 for individual, $35 for family Signature _________________________ Date _________________ Please make checks payable to: Artists in Action Mail to: Artists in Action, PO Box 2684, Salem OR 97308-2684 |
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