Membership Application
(Print out this application from your computer, fill it in and submit it to the Membership Chairman)
If you are mailing it, send to: Verksted Gallery, PO box 922, Poulsbo, WA 983790

I have read the application information and wish to apply for membership.

( please print clearly)

Name______________________________________________________Phone_________________________

Address____________________________________________________City___________________________

Email address_________________________________________WebSite______________________________

Washington Dept of Revenue Registration #______________________

My art medium is:___________________________________________________

(please provide a short statement) I am applying for membership because:


 

I will bring the following artwork to the initial screening. (Do not bring more than five items. Clearly mark them with retail prices)

1.
 

2.
 

3.
 

4.
 

5.
 

Please contact the current Director of Membership to submit your application and set up your screening interview. The current Membership Chairman is Lynn Lever. You can call her at 360-297-4096 for more information