Artist Membership Form

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Name





Home Address






We need to collect county information for grant purposes.
Contact Information





Organization Address






We need to collect county information for grant purposes.
Organization Contact Information



Arts Interests
Select all areas of arts and entertainment for which you have particular interest or experience





Demographic Data

To aid us in applying for grants, we ask that you answer the following Demographic Data questions.
This information is kept in confidence and only used in the aggregate.

For grant purposes

[OPTIONAL]

[OPTIONAL]

[OPTIONAL]
Membership


Please Note: If you have a current legal issue, you must indicate so on this form. If you do not indicate that you have a current legal issue, GLA will not contact you to schedule an intake.



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