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: