Print-and-Send Membership Form

MEMBERSHIP

To join online visit our PayPal membership page.

You can print this page directly from your browser!

Please complete this form and mail it with a check
made out to C.L.A. for the appropriate fee,
or with a credit card number, type of credit card,
and expiration date to:

Attn. Membership

California Lawyers for the Arts
Fort Mason Center, C-255
San Francisco, CA 94123

Or, fax with credit card info to: (415)775-1143

___ New Membership ___ Renewal

INDIVIDUALS

___ $20 Senior Citizens

___ $20 Full -time Students

___ $25 Working Artists

___ $40 General Individual

___ $60 Panel Attorney (attach Panel application)

___ $60 Lawyer Member

___ $100 to $1000 Patron

ORGANIZATIONS/BUSINESSES

___ $50 Small Organization (Budget less than $100,000)

___ $90 Large Organization (Budget of $100,000 or more)

___$100 to $1000 Corporate Sponsor

Name (please print) ___________________________________________________

Mastercard or Visa # ________________-_______________-_______________
Credit Card Expiration Date: ____ /____ / ____

Organization/Firm___________________________________________

Street Address_________________________________________________

City/State/Zip _____________________________________________

Home Phone: ____________________________

Work Phone: ____________________________

Fax: ________________________________

e-mail: ______________________________
I would prefer to receive mailings as e-mail ___

Do not release my name for arts opportunities ___

Please complete the following information about your discipline or profession.
You may check as many as you like.

VISUAL ARTS:

___ photograper

___ graphic artist

___ painter

___ printmaker

___ sculptor

other ______________________

PERFORMING ARTS:

___ musician

___ dancer

___ painter

___ singer

___ theater artist

other ______________________

LITERARY/MEDIA ARTS:

___ writer

___ publisher

___ filmmaker

___ video artist

other ______________________

ALLIED DISCIPLINE:

___ arts administrator

___ agent

___ attorney

___ accountant

___ appraiser

___ student: discipline ________________

other _________________

Webmaster: Josie Porter