Membership Application

Please complete this form, attach eight photos of your work, and return to: AAC Membership Committee attn: Susan Bornstein 883 H St. Arcata, CA 95521

Date: _____________________________

Name: ____________________________________________________

Address: ___________________________________________________

Phone: __________________________Email ______________________

Other Phone: ________________________________

Best time to call: __________________________________

Medium, size, price range of your work:

Description of your work (please be specific):

Website showing your work: _______________________________________

Thank you for your interest in Arcata Artisans Cooperative Gallery/Store.