STUDIO MEMBER

STUDIO MEMBER

Welcome! Your membership fees contribute towards sustaining the studio for its members and the wider community Thank you for your support
Name*

first namesurname
Number*
All members require a Gmail address to access the studio calendar. What is your Gmail address?*
Gmail address
Preferred contact email if different from above
Address*

Street Address line 1

Street Address line 2

City

postcode
Date of birth*

MonthDayYear
Date
What do you do? Please select as many as applicable to you*

ArtistAnimatorCollege/university technician/lecturerCopywriterDocumentary/film-makerGraphic designerIllustratorHobbyistJust graduatedPhotographerPrintmakerRetiredSet designerStudentUnemployedWeb designerOther
STUDIO MEMBERSHIP
Which induction are you attending?*

Paper screenprintingTextiles screenprintingRiso printing
Have you been a member of a print studio before?

Yes (go to the next question)No (skip the next question)
What is the name of the studio you previously held a membership with?

On a scale of 1-5 how would you rate your experience as a printmaker?*

	1	2	3	4	5

1 is I've done a course, 5 is I'm a professional

Please describe the experience you have had.*
What do you hope to get from your membership?*
Following the induction you become a Pay-As-You-Go member unless you are an experienced printmaker and would prefer to opt for Full membership.*

Pay-As-You-Go for meFull membership for me
SOCIAL MEDIA
Do you give permission to have photos of you and/or your work shown via Printhaus Instagram, FB and/or website?*

YesNo
If "yes" please provide the relevant social media tags. *
(eg. INSTA - @theprinthaus WEB - theprinthaus.org)
Would you take part in short video interviews about your work, giving mini-tutorials or anything else of a similar nature?*

YesNo
MEDICAL INFORMATION
Emergency contact 1*

first namesurnameCONTACT NUMBER
Emergency contact 2

first NamesurnameCONTACT NUMBER
Please select those applicable to you:*

Allergies eg. food/materialAllergies to known drugsAsthma/bronchitisDermatitisDiabetesFits/faintingHeart conditionInjuries/breaksJoint problemsSevere headachesn/a
Have you received tetanus in the last five years*

YesNo
Are you receiving medical/surgical treatment of any kind?*

YesNo
Do you suffer with any other physical/medical ailment(s) other than those listed above?*
If not, please indicate n/a
If you answered "yes" to any of the above please provide the specifics.
STUDIO TERMS & CONDITIONS
LAST BUT NOT LEAST
How did you find out about the membership?*
Thank you for completing this form
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