Membership Application Form

Middle Street Gallery

Name: ________________________________________________________________________________________

Primary Address: ________________________________________________________________________________

Secondary Address (studio, weekends): ______________________________________________________________

Phone numbers: Home: __________________  Secondary:  __________________ Mobile: _____________________

Email address(s): ________________________________________________________________________________

What is/are your medium/s (painting, sculpture, photography etc.): __________________________________________

_______________________________________________________________________________________________

Why are you interested in joining Middle Street Gallery: ___________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________

_______________________________________________________________________________________________

Do you have specific talents and/or interests that may help the functioning of the gallery and that you are willing to contribute: ______________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

Attached to this application form are (please check):

At least 3 images of recent work with dimensions and medium stated

A link to your website or one that includes images of your work

My artist statement

My bio

Date:

Signature: