Membership Form Contributor Benefactor Member April 5, 2022 Add New Membership Complete the form below to create a new Membership. Once all the required fields have been completed, click the Save New Membership button to save your membership. Membership Type Artist Membership Supporting Membership Contributing Membership Membership Subtype Single Membership 1 year $65 2 year $120 1 year $95 2 year $175 1 year $65 2 year $120 Generous Member ($130-$300) Benefactor Member ($300+) Booth Backer First Name: Last Name: Business Name (This information will be listed first on the roster): Address: City: State/Province: — AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA DC WV WI WY AB BC MB NB NL NS NT NU ON PE QC SK YT Zip/Postal Code: Primary Phone (###-###-####): Other Phone (###-###-####): Fax (###-###-####): Website URL (http://): Email Address: Next Show Date: Next Show Date: Login Information Username: Password: Volunteer Opportunities – Newspaper – Membership – Public Relations – Educational Programing – Fund Raising – Other How did you hear about NAIA? From time to time NAIA sells our mailing list to art shows or other art show related businesses, however you have the option to “opt-out” of this NAIA income stream. Will you allow your addresses to remain on the mailing list for this purpose? (If box remains unchecked, your email address will not be used). Yes, you have permission to use my mailing address. Billing Information Same as above First Name: Last Name: Address: City: State/Province: — AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA DC WV WI WY AB BC MB NB NL NS NT NU ON PE QC SK YT Zip/Postal Code: Coupon Code: Credit Card Information Name as it Appears on Card: Credit Card Number: Expiration Date Month: — 01 02 03 04 05 06 07 08 09 10 11 12 Expiration Date Year: — 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 Security Code: Related Posts WEB RESOURCES NAIA AT WORK NAIA CLASSIFIED ADS About The Author Vadim Melnik Add a Comment Cancel replyYou must be logged in to post a comment.