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APPLICATION FOR MEMBERSHIP
Date:
____________________
Artist’s Name:
_____________________________________________________________
Address: ____________________________ City: __________________ Zip:
__________
Phone: __________________________ County: _______________
E-Mail Address:
____________________________________________________________
Web Address ______________________________________________________________
One sentence description of your art or craft:
______________________________
____________________________________________________________________________
____________________________________________________________________________
Do you have a current business plan? Yes
No
Do you have and know how to use a computer?
Yes No
Are you connected to the Internet? Yes
No
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The following
information will help us with statistics greatly needed for grant
applications, but not required: |
Number of Adults in
your household _____
Number of Children in you household _____
Which of the Annual Income category does your household fall into:
_____ $0 - $13,000
_____$13,001 - $15,000
_____$15,001 - $20,115
_____ $20,116 - $25,343 _____ $25,344 - $29,823
_____ $29,824 - $33,392
_____ $33,392 - above
Do you consider yourself to be: (check as many as pertain to you)
_____ Native American _____ Asian _____ Caucasian
_____ Hispanic/Latino _____ African American _____Pacific Islander
_____ Other
Which of the following Age Groups do you fall into:
_____ 18 - under _____ 19 - 64 _____ 65 - over
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