UCAE Membership Renewal Form

You may either pay with Paypal or complete this form, then print for mailing with your check for membership.

Dues: Student: $35 Individual: $60 ($20 of which goes to UCAE Fund*) Institutional-up to 3 members: $100 Life Membership $500

* The UCAE Fund was established in 2001 to support exemplary art education. Contributions are fully tax deductible.

Title (Mr., Ms,. Dr.)

Name:

First

Last

Preferred E-mail Address:

Today's Date:

day

month

year

Home Address:

Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip Code

Professional Affiliation

Department:

Academic Rank or Title

Work Phone:

Area Code

Phone Number

I would like to recommend the following visual arts leader(s) or institution(s) for membership [include contact information]:

Comments, suggestions, and recommendations for future UCAE activities:

Pay Pay Payment for:

OR Print and Mail this form with a check

My check (payable to UCAE) is enclosed in the amount of: