EPAA New or Renew Member

New or Renewal, Choose One:*

New MembershipRenewing Membership
Full Name*

First NameLast Name
Business Name (Business Memberships only)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*

Confirmation Email
Primary Phone Number*

Area CodePhone Number
Alternate Phone Number

Area CodePhone Number
Website or Business Address (Optional)
If you are renewing, is any information above new?

AddressEmailPhone
We would like to know more about our members so we can better serve you. Please let us know about yourself. Or if you prefer not to answer, that is okay too.
GENDER

MaleFemaleOther
AGE

Under 2526-3536-5051-66+
ETHNICITY

HispanicWhiteAfrican AmericanNative AmericanOther

Annual Membership Fee (Choose One)*

General Membership$35.00

Senior Membership (65 or older)$30.00

Military or Spouse Membership (w/ID)$30.00

Student Membership (25 years and under : Enrolled)$20.00

Business Membership (Choose a Class)$50.00

Class
Item subtotal:$0.00

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Total $0.00

Your Art Medium
Select yes or no to be added to the "proposed" EPAA Members Directory on our Website*

Yes, and I will add my information below.No, not at this time.
Artists Biography (suggested)
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Artists Statement (suggested)
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Check below to Volunteer. We will phone or email you to discuss options.

Yes, I want to volunteer my time to help the EPAA
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