Artist's Name: Date:

Name of Significant Other (optional):

Mailing Address:

Telephone  Day:                      Evening:    email Address:

*General Excise Number:     *Social Security Number:

* These numbers are MANDATORY.  No numbers, no CHECK!

Art Medium:                                         

Education:                                           

Volunteer Skills:                                   (eg: gallery sitting, carpentry, painting, typing, teaching, fund raising, publicity, other...)

Teaching Experience:                        

Artist's Statement About Your Work:

How Long Have You Resided on Maui?

Why do You Want to Join LAS?        

Mahalo for your interest in joining the Lahaina Arts Society!  We will be in contact with you very soon!