Queer Caucus for Art
An affiliated society of the College Art Association

MEMBERSHIP FORM
New member _________ Renewal __________


Please printout this page, supply complete mailing address, and mail with payment to Amy Cancelmo at address below. Information beyond name and mailing address is optional. Thank you.

Name and full mailing address with postal code


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If you are using your home address as mailing address, please indicate affiliation if appropriate:


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Phone (include area code)
(home)

(work)

Email

Please specify:

______Artist

______Art historian

______Other___________________


Suggested annual dues:
$25.00 Employed fulltime
$10.00 Student, freelance, unemployed, retired, other

Amount enclosed: $____________ (membership)
N.B. Payment should be in U.S. dollars. If you live outside the U.S., the PayPal option on http://artcataloging.net/glc/glcn.html will allow you to pay in your currency and we will receive a U.S. dollar amount. Thank you.

Make checks payable to QCA and mail to:
Amy Cancelmo
qcatreasurer@gmail.com


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