LIAA Individual Membership Form

Become an LIAA Member!

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

Initiating New Membership Renewing Membership
Your Name *

First Name Last Name
Your E-Mail *
example@example.com
Phone Number

Area Code Phone Number
Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Organization/Company (if applicable) *
Title (if applicable)
Do you identify as any of the following? (Check any or all boxes that may apply)

African / African American / Black Arab / Middle Eastern / North African Asian / Pacific Islander Latino / Latina / Latinex Multiracial Native American / Indigenous / American Indian White
How would you describe your gender (Check any or all boxes that may apply)

Female Male Non-binary / third gender Prefer not to say Prefer to self-subscribe
What is your affiliation with the arts, culture, and creativity? (Check any or all boxes that may apply)

Artist Arts administrator Arts advocate Arts educator Arts lover Grantmaker Policymaker
Social Media
Facebook?
Instagram?
Website?
Membership Level

LIAA Individual membership dues are $45.00 annually. Please note that we are waiving our membership fees for the year in recognition of the challenging post-COVID realities that so many of our region’s arts and culture organizations and local artists are facing. If you are still willing and able to pay your annual dues to join, you may do 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 Dues

1 Year Membership $ 45.00

2 year Membership $ 90.00

Total $ 0.00

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

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Become an LIAA Member!

Social Media

Membership Level