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New Member Form - Pay By Check
Organization Information
Organization Name
*
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
Administrative 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
Logo
Requirements: Format - JPG or PNG | File Size - 1MB or less
Primary Contact Information
Please list the person in your organization who should be the primary contact regarding Membership information.
Name
*
First Name
Last Name
Title
Primary Contact Email
*
Verify Email
*
Directory Email Address
*
This email address will appear in our Member Directory (we recommend using an address used for general inquiries.
Verify Email
*
Membership Dues and Payment
Your LIAA membership payment is based on your organization's annual operating expenses.
Membership Dues- Nonprofit Organization
Annual membership dues are based on your organization's reported annual operating budget,
see chart below:
Annual Operating Expenses
Membership Dues
Under $250,000
$75.00
$250,000 - $499,999
$150.00
$500,000 - $999,999
$250.00
$1 - $4.9 Million
$375.00
$5 Million and above
$475.00
Commercial (for-profit) Entities
$500.00
Educational Institutions
$2,500.00
I pledge to remit the following amount based on the chart above within 30 days:
$75 - Annual Operating Expenses Under $250K
$150 - Annual Operating Expenses $250K - $499K
$250 - Annual Operating Expenses $500K - $999K
$375 - Annual Operating Expenses $1M - $4.9M
$475 - Annual Operating Expenses $5M +
$500 - Commercial Entities
$2,500 - Educational Institutions
Please mail your check to our temporary remote address:
Long Island Arts Alliance
PO Box 1472
Patchogue, NY 11772
