Membership Application
Date
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
example@example.com
Check applicable box:
*
New Applicant
Renewal
Will you be an exhibiting artist?
Yes
No
In what areas? Check all that apply.
Jewelry
Pottery
Photography
Sculpture
Wood
Painting
Glass
Fiber
Metals
Painting
Literary
Other
Membership Year is July 1st through June 30th
Please check the committees you'd like to serve on:
Comm. Outreach
Grants
Pub./Newsletter
Display -Exhibits
Purchasing
Fundraising
Membership
Jury
Refreshments
Workshops
Youth Programs
Merit Award
Gallery Volunteer
Social Media
Finance
Membership Levels
prev
next
( X )
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
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Capital Campaign Donation
$
50.00
Help PAL complete its new location!
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Item subtotal:
$
0.00
Total
$
0.00
Credit Card
First Name
Last Name
Credit Card Number
Security Code
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
Expiration Year
Would you like to volunteer at PAL?
Yes
No
If yes, please describe your area of interest or expertise
Enter the message as it's shown
*
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