Membership Application

Cedar Keyhole, Inc.

Artist Co-Op

Mailing Address

Name_____________________________________________________________________________________________

Address___________________________________________________________________________________________

City_____________________________________State______________Zip Code______

County of Residence__________ Home Phone__________Work Phone_________

E-Mail Address_____________________________________________________________

Application is for   □ Full Membership   □ Part-Time Membership   □ Consignment

Medium 1: _________________________________________________________________________________________

Price Range $_______________________

Description of Work

__________________________________________________________________________________________________

__________________________________________________________________________________________________

Medium 2:

Price Range $_______________________

Description of Work

__________________________________________________________________________________________________

_________________________________________________________________________________________________

References (Include present/previous employer, character, or co-op member)

Name_____________________________________ Address__________________________________________________

Phone Number_____________________________

Name_____________________________________ Address__________________________________________________

Phone Number_____________________________

Name_____________________________________ Address__________________________________________________

Phone Number_____________________________

Sponsoring Co-Op Member (if applicable)_________________________________________________________________

Items Submitted with Application

Title (if any)________________________________________________________________________________________

Description_______________________________________________________________ Price_____________________

Title (if any)________________________________________________________________________________________

Description_______________________________________________________________ Price_____________________

Title (if any)________________________________________________________________________________________

Description_______________________________________________________________ Price_____________________

Do you  have your for sale on a consignment basis anywhere in Cedar Key? __________

How important is it to you for your work to sell?__________________________________________________________

How did you hear about the Cedar Keyhole, and why do you want to join?_____________________________________

___________________________________________________________________________________________________

I have read all of the information contained in this artist membership application, and if accepted, I hereby agree to abide by all the rules and policies of the Cedar Keyhole, Inc.