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 MembershipRenewing Membership
Your Name*

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

Area CodePhone Number
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
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 / BlackArab / Middle Eastern / North AfricanAsian / Pacific IslanderLatino / Latina / LatinexMultiracialNative American / Indigenous / American IndianWhiteOther
How would you describe your gender (Check any or all boxes that may apply)

FemaleMaleNon-binary / third genderPrefer not to sayPrefer to self-subscribeOther
What is your affiliation with the arts, culture, and creativity? (Check any or all boxes that may apply)

ArtistArts administratorArts advocateArts educatorArts loverGrantmakerPolicymakerOther
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!