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.

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

Become an LIAA Member!