AU Artist Membership Application Form

Art Upstate Artist MEMBERSHIP APPLICATION
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number

Area CodePhone Number
The following information will be used for entry into our Artists Directory.
Medium
Website
Social Media Sites (please add links)
Artists' Bio

Upload a File

Cancelof
Artists' Image #1

Upload a File

Cancelof
Artists' Image #2

Upload a File

Cancelof
Artists' Image #3

Upload a File

Cancelof
Artist Membership Fee
prevnext( X )
Your Annual Membership Fee is$35.00
Membership is valid for one year and is renewable on your anniversary date.
Let us know what's on your mind.
Should be Empty: