VALA Membership Renewal Form
Thank you for being a valued member of VALA! We value you as and Artist and Member!
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
-
Area Code
Phone Number
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Are you a Professional Artist?
*
Yes
No
Would like to be
Do you have a Website?
*provide link here (http://...)
Instagram?
Instagram handle
Facebook?
FB Address
Comments and Suggestions?
How can VALA be a better organization?
Annual Membership Dues
*
prev
next
( X )
VALA Membership
(
$40.00
$
40.00
for each
year
)
VALA Membership (Senior Citizen 55+)
(
$20.00
$
20.00
for each
year
)
VALA Membership (Students HS or College)
(
$20.00
$
20.00
for each
year
)
Email
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Submit
Should be Empty: