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______________________________________________________________