Application For Membership Artist's Name* First Last Home Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneWork PhoneMobile PhoneFaxEmail* Artist's Medium* Please create and submit a Jury Packet, including the following items: A completed Application for Membership form. 5- 10 color prints of ALL types of work you anticipate including in your studio/gallery. Actual work may be submitted, but ONLY at your own risk. We assume no liability for theft, damage, etc. A detailed resume if available. A concept sheet describing what a visitor would experience upon entering your studio/gallery. A non-refundable Jury Fee of $50.00. Please make check or money order out to “City Market Art Center.” Please read the following statement and check the box before submitting.*I understand that the jurying process that I hereby request in the initial step in being invited to occupy studio/gallery space in The ART Center at City Market. I acknowledge that selection will then be based on the availability of studio/gallery space, the compatibility of my medium/media focus to the current combination of artwork present (as this applies to compliance with the educational component of a non-profit organization [501 c 3]) and/or an invitation by an established artist group to join them in a studio/gallery space occupied by the group. If I have submitted actual artwork, I understand that I assume full risk in doing so. I have read and agree to the above statement.PhoneThis field is for validation purposes and should be left unchanged.