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TEAM Membership Application Western Region

Fill out the information in this form. PRINT copy to send with dues to W Region Treasurer (address below).
Use Tab Key Not Enter Key To Change Fields!    All Fields Are Required

Region:

First Name:

Last Name:

Address:

City:

State:

Zip:

Telephone Number:

E-Mail Address:

Teacher: Yes / No     (Continued on Next Column)

Your Website Address (if Applicable)

ART EDUCATION (Schools, Teachers):

PROFESSIONAL or BUSINESS BACKGROUND(Companies and Dates):

ART ORGANIZATION AFFILIATIONS(include dates):

PREVIOUS EXHIBITIONS & JURIED SHOWS,

indicate Solo (S) Group (G) or Club (C):

COLLECTIONS (Public or Private):

CURRENTLY TEACHING AND WHERE:
Edit carefully!  PRINT a copy to send in with dues and for yourself! Now click SUBMIT!   Welcome!

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