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:
Will you be an exhibiting artist?
In what areas? Check all that apply.

Other
Membership Year is July 1st through June 30th
Please check the committees you'd like to serve on:
As a 501(c)(3) charitable organization, your donations and membership dues paid to PAL qualify as a deduction on your tax return.

Student (18 to 25)$10.00

Individual$35.00

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:

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