LIAA Member Organization Form

Become an LIAA Member!

Please complete the form to initiate or renew your LIAA membership.
Today I am *

Initiating New Membership Renewing Membership
Name of Organization/Company *
Are you a non-profit 501(c)(3) organization

Yes No
Your Name *

First Name Last Name
Title *
Your E-Mail *
example@example.com
Organization's General Email
info@example.com (this will be used on the member directory)
Phone Number

Area Code Phone Number
Organization./Company Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Should we contact you or someone else about membership updates? *

Me Someone Else
Membership Status Contact Email
example@example.com
Organization/Company Website *
Donation Page URL
If applicable, please include the direct URL to your organization's donation page
Which of the following categories includes your organization's operating budget pre-COVID? *
We need this information to process your membership.
Mission Statement
Check this box if your organization predominantly serves or engages ALAANA (African, Latinx, Arab, Asian, or Native American) communities:

Yes No
Organization / Company Focus *
Please select the category that BEST describes your primary purpose or artistic discipline.
Upload your logo (300px X 210x preferred)

Browse Files

Cancel of
Social Media Information

Please provide the complete url for your social media pages. Example, Long Island Arts Alliance Facebook Page: https://www.facebook.com/ArtsLongIsland
Facebook Page
Instagram Page
Twitter Page
Membership Level
LIAA membership dues are based on your organization's annual operating budget. Please select the correct option below.

In addition to your membership benefits, your contribution supports the development of programs, policies, and opportunities for Long Island's creative sector.
Do you want to take advantage of the offer to waive your membership dues for the year?

YES! No, I am in the position to be able to pay my annual dues

Membership Levels *

Not-for-profit cultural organization (up to $250K Annual Budget) $ 75.00

Not-for-profit cultural organization ($250K - $500K Annual Budget) $ 150.00

Not-for-profit cultural organization ($500K - $1M Annual Budget) $ 200.00

Not-for-profit cultural organization ($1M+ Annual Budget) $ 275.00

Total $ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Should be Empty:

Become an LIAA Member!

Social Media Information

Membership Level