Membership Form Name:* First Last Company NameAddress* 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?*YesNoPhone:*Email* I am an:*Art appreciator / sponsor / patronArtist (Regular member)Student Artist (Full Time Student Only)If a Student, enter your full-time school nameWhat 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 TypeRegular MembershipStudentTotal $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged.