Please printout this page, supply complete mailing address, and mail with payment to Susan Aberth at address below. Information beyond name and mailing address is optional. Please note special offer on four journals from Haworth Press. 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
$5.00 Student, other
$30.00 Foreign (in U.S. currency)

Amount enclosed: $____________ (membership) $______________ (journal offer)

Make checks payable to QCA
and mail to:
Susan Aberth
P.O. Box 518
Tivoli, NY 12583

The Caucus produces a membership directory; please let us know if you want to be listed (circle yes or no below).
Yes, I want my name, address, affiliation, phone, fax, and email included.
No, I do not want to be included.