PAL Membership Application

Membership Application
Date

MonthDayYear
Date
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email
example@example.com
Check applicable box:*

New ApplicantRenewal
Will you be an exhibiting artist?

YesNo
In what areas? Check all that apply.

JewelryPotteryPhotographySculptureWoodPaintingGlassFiberMetalsPaintingLiteraryOther
Membership Year is July 1st through June 30th
Please check the committees you'd like to serve on:

Comm. OutreachGrantsPub./NewsletterDisplay -ExhibitsPurchasingFundraisingMembershipJuryRefreshmentsWorkshopsYouth ProgramsMerit AwardGallery VolunteerSocial MediaFinance
As a 501(c)(3) charitable organization, your donations and membership dues paid to PAL qualify as a deduction on your tax return.

My Products

Student (18 to 25)$10.00

Individual$30.00

Family$50.00

Supporter$75.00

Patron$100.00

Benefactor$250.00

Youth (under 18)$ Free

Suzanne Towe Haste Merit Award$5.00

Quantity

Capital Campaign Donation$50.00

Help PAL complete its new location!

Quantity
Item subtotal:$0.00

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country