MEMBERSHIP FORM
I want to become a member of the Prince Edward IslandCouncil of the Arts.
Please complete one form per member
.
□ Yes, I would like to become a member of the PEICA□ I would like to be listed on the PEI Artists Director y (www.peiartists.ca)□ I wish to make an additional donation to support the PEICA in the amount of $______
Member Information
Name: __________________________________________________________________________________ Address _________________________________________________________________________________ City/Town_____________________________________________________ Postal Code ________________ Telephone _____________________________________E-mail _____________________________________
Membership Type
(
Check one - see reverse for instructions
) Fees
1 year 2years
Individual □ $5 □ $10Family (Name: ________________________________________________________)First member □ $5 □ $10 Additional Member □ $2 □ $4Organization (Name____________________________________________________ Size ____
people
)Organization Fee □ $5 □ $10Additional Member □ $2 □ $4
Memberships expire one or two years from date of purchase.
Select Discipline:
□ Craft □ Music□ Dance □ Theatre□ Film & Video □ Visual Arts□ Interdisciplinary Arts □ Writing & Publishing□ Member-at-large (no specic discipline)
Payment
Amount enclosed: $________________ □ Cheque (payable to the Prince Edward Island Council of the Arts)□ Money Order □ Cash (Drop off only. Do not mail)Signature__________________________________________________________ Date__________________
Privacy
The PEICA holds high standards for privacy and condentiality. If you have any questions concerning the use of
your personal information or the PEICA’s privacy policies please contact us.
The Prince EdwardIsland Council of theArts…making the Artsintegral to the lives of all Islanders.Your membership showsyour commitment to thefuture of the Arts onPEI.
Please mail or drop off this form, along withyour payment, to:
The Prince Edward IslandCouncil of the Arts115 Richmond StreetCharlottetown PE C1A 1H7
For more information about membershipwith the Prince Edward Island Council of the Arts, please visit our website at
,or call 1-902 368 4410 or 1-888-PEI ARTISTS.
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