WURTSBORO ART ALLIANCE
P O Box 477 Wurtsboro NY 12790
Membership Application
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Annual Dues
O ARTIST O Patron O Benefactor
( ) $30.00 Single
( ) $40.00 Family
( ) $20.00 Student (members under 18 must have a parent or guardian countersign this application)
NAME________________________________________________________________________
Last First initial
( ) Seasonal Resident
MAILING ADDRESS_____________________________________________________________________
PHONE____________________________EMAIL_____________________________________
Web-Site______________________________________________________________________
MEDIUM: _______________________________________________
Please write a brief description of your work:
All members are expected to participate in Gallery coverage on weekends, the hours are:
12Noon to 2pm and 2pm to 4pm Saturday and/or Sunday
In addition: Special events and Gallery openings may extend the hours
Regular meetings are held the first Tuesday of each month; members must attend and participate in maintaining and supporting the Art Alliance. Without member support and participation the Gallery cannot survive. Our goal is to provide an outlet for the beginner and professional alike to present their work to the public and make the world a more beautiful place
Additional areas you may be interested in helping are:
( ) Publicity ( ) Fundraising ( ) Workshops ( ) Demonstrations
( ) Special events ( ) Graphics ( ) Grant Writing
WAA Indemnification Agreement:
I, .....................................................................residing at..........................................................
......................................................... hereby agree to indemnify and hold harmless the
Wurtsboro Art Alliance and/or any member thereof, in the event of any theft, loss or damage of
any kind to any of my artwork(s). I further agree not to seek legal remedies which may be available
to me against the Wurtsboro Art Alliance or any of its members in the event of any such damage
my art work(s).
I have been made fully aware and I understand that the Wurtsboro Art Alliance has no
insurance which covers theft or damage to my artwork(s)
I understand that acceptance of my membership is contingent on signing this waiver.
(Members under 18 must have a parent or guardian countersign on their behalf.)
Press Release
I hereby give permission to the Wurtsboro Art Alliance to use images of my work for press releases.
X............................................................. Date.................................................
Note Cancelled check will be proof of membership
(Please be sure to print, sign and date this form then send it included with a check for the appropriate amount to: WAA Gallery P.O. Box 477 Wurtsboro, N.Y. 12790)
