THE ARTIST LOFT GALLERY
367 Anderson Avenue
Coos Bay, Oregon 97420
541-756-4088
APPLICATION FOR MEMBERSHIP
NAME_____________________________________________________________________ DATE______________________
ADDRESS________________________________________________________________________________________________________________
CITY________________________________________________________________________STATE__________________ZIP CODE_____________
HOME PHONE_____________________________________ CELL PHONE______________________________________
EMAIL___________________________________________________________________________________________________________________
ART MEDIUM_____________________________________________________________________________________________________________
EXPERIENCE, CREDITS AND EXHIBITS
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MEMBERSHIP (CHECK ONE)
__FULL MEMBERSHIP (Monthly Dues $50/ Commission 25% and working at the Gallery
a few hours per month)
__HALF MEMBERSHIP (Monthly Dues $25/ Commission 35% and working at the Gallery
a few hours per month)
__EXHIBITOR or GUEST ARTIST (Monthly Dues Not Applicable/ Commission 45%)
A complete membership agreement will be provided upon acceptance to THE ARTIST LOFT GALLERY, 367 Anderson Avenue, Coos Bay, Oregon 97420
PLEASE RETURN THE APPLICATION TO THE ABOVE ADDRESS
ARTIST'S SIGNATURE______________________________________________________________