Membership Form Name:* First Last Company Name Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Do you want this address published in the next printing of the membership directory?* Yes No Phone:*Email* I am an:* Art appreciator / sponsor / patron Artist (Regular member) Student Artist (Full Time Student Only) If a Student, enter your full-time school name What are your artistic interests/ what media do you use? Below are some general categories, we will ask for more detail in the next question. Please check all that apply* Photography Drawing Painting Carving / Manipulate found objects Sculpture Pottery Weaving Textiles Other Please provide more detail about your artistic interests (i.e., do you do Oil Painting, Pencil Drawing, Metal Structures, Clay Sculpture, Miniature Models, etc?)What other talents would you like to share with the Art Guild (i.e., web design, accounting, marketing, musical, etc...)?Notes or questions about membership you would like us to know:Membership Type Regular Membership Student Total $0.00 Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged.