Art Gallery Membership Tier Application

Full Name

First NameLast Name

Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Mailing Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Date of Birth

Date

Individual Membership

Access to exhibitions, member newsletter, and event invitations.

$60.00

Family Membership

Benefits for up to 4 family members, plus all individual perks.

$100.00

Patron Membership

All family benefits plus exclusive previews and special recognition.

$250.00

Total

Which art forms are you most interested in?

Would you like to receive our monthly newsletter?

Are you interested in volunteering at gallery events?

How did you hear about our gallery?

Emergency Contact Name

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Please share any additional comments or questions: