ONLINE REGISTRATIONFORM
MEMBERSHIP CATEGORY:
INDIVIDUAL
SENIOR
STUDENT
HANDICAPPED
FAMILY
GROUP
ORGANIZATION
WEB OPTION
NAME:
COMPANY:
ADDRESS:
CITY:
STATE:
ZIP:
PHONE:
FAX:
ALT CONTACT:
ALT PHONE:
E-MAIL:
SELECT:
VISUAL ARTIST
LITERARY ARTIST
PERFORMING ARTIST
SUPPORTER
PROFESSION:
RETIRED? YES NO
ARTISTIC BACKGROUND:
AREA OF INTEREST:
Would you be interested in volunteering? Yes No If Yes, please check areas of interest below
EVENTS
PUBLICITY
MEMBERSHIP
FUNDRAISING/GRANTS
FINANCE
NEWSLETTER
SPACE/VENUES
VOLUNTEER COORDINATION
MEDIA
ADMINISTRATIVE
COMMUNITY CONTACT
MARKETING/ADVERTISING
OTHER:
List friends who may be interested in supporting AIP.
1.
2.
3.
ARTIST DUES:
Individual $20 Senior/Student/Handicapped $15 Family $35 Organization $40 Web Option $20
