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New Individual Member
Your Information
Your Name
*
First Name
Last Name
Organization Name (if applicable)
Business Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Mailing Address
*
Is the address above where you would like to receive mail?
Yes
No, I'd like to provide a different mailing address
Mailing Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Email
*
Verify Email
*
Phone Number
Website
Please include the full url: example: https://www.organization.org
Facebook
Please include the full url: example: https://www.facebook.com/ArtsLongIsland
Instagram
Please include the full url: example: https://www.instagram.com/ArtsLongIsland
Twitter
Please include the full url: example: https://www.twitter.com/ArtsLongIsland
What is your affiliation with the arts, culture, and creativity? (Check any or all boxes that may apply)
Artist
Arts administrator
Arts advocate
Arts educator
Arts lover
Grantmaker
Policymaker
Do you identify as any of the following? (Check any or all boxes that may apply)
African / African American / Black
Arab / Middle Eastern / North African
Asian / Pacific Islander
Latino / Latina / Latinex
Multiracial
Native American / Indigenous / American Indian
White
How would you describe your gender (Check any or all boxes that may apply)
Female
Male
Non-binary / third gender
Prefer not to say
Prefer to self-subscribe
Membership Dues
All annual Individual Memberships are $45
Membership Payment
*
$45
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Individual Membership
