Gallery Membership Form PDF

Gallery Membership Application Please print clearly Gallery Name: Gallery Mailing Address: Apt/Suite #: City: State: Postal Code: Country: Gallery Primary Phone: Ext: Fax: Gallery Secondary Phone: Website: Gallery Primary Contact First Name: Email: Last Name: _______ Gallery Membership Benefits:
Gallery Membership……………. $350 How did you hear about nceca? (Check all that apply)  Past Member  Referred by member  NCECA Poster  NCECA Website  News/Publication  Facebook/Twitter  Regional Event  Teacher/Professor  Previous Conference Attendee  Other________________________________ 
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Access to Web‐based Member Directory Gallery’s ‘Live Link’ logo on the nceca website 20% discount on Gallery Expo booth and priority notice Gallery Event Posting 
One (1) complimentary linked logo placement annually in the nceca monthly e‐news 
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Discount on Regional Mailing List Hotel block advance notice Promotion Material Exchange Gallery/Collectors programming opportunities Individual Standard Membership for the Gallery Primary Contact PAYMENT METHOD: (Select One) Credit Card:  Visa  MasterCard  Amex  Discover #: __________‐ ____________ ‐ ___________‐ _____________ EXPIRATION DATE: ____/____ (Please Print name as it appears on Card): CVV ______ Authorized Signature: Billing Address: ______________________________________City_______________________State_____Zip_____________  Money Order ____________________________ Money Orders must be in U.S. dollars.  Check #__________________ (Checks payable to nceca must be drawn on a US bank.) (Returned checks will incur a $25 processing fee.) Mail or email completed form with payment to: nceca Membership 4845 Pearl East Circle, Suite 101 Boulder, CO 80301 office@nceca.net Website: www.nceca.net Phone: 303‐828‐2811 
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