ECOAA MEMBERSHIP FORM 2019

Enclosed is the amount of 

	$40.00 for  2019 membership year in ECOAA
	$80 for 2019 & 2020 membership in ECOAA

(ECOAA Membership is valid from January 01 to December 31 of any given year).

Please PRINT!

First Name 				   Last Name 							

Street 													

City 					_ Province _______   Postal Code				 

Telephone ______		________Email 							

Website  												

		New Member		                           Renewing member

Please note that a members list is sent to all members once a year 
Do you wish your street address details in this list?  Please indicate which option you need.

	All information
	Town only
	Telephone number
	E mail address 
	Name only
Do you give ECOAA permission to use your image for promotion (social media, website and print) 

	YES 
	NO 

My painting medium is ___________________________

I would be willing to serve on a committee   __________

Please make check payable to East Central Ontario Art Association, or ECOAA, and mail to:

ECOAA MEMBERSHIP
c/o Leigh Thompson
BOX 329
HASTINGS, ON. K0L 1Y0