Central Ontario Art Association (COAA)

Online Membership Application Form:

Section 1: Member Order Details All fields marked with a * are required.
Name:	*
Address:	*
Postal / Zip Code:	*
Home Phone Number:	*
Mobile Number:
Email:	*
Website:
What meduim(s) do you work in?
Do you teach art? What do you teach?
Please Check ONE:	Yes, I would like to receive the newsletter by e-mail (Note: Will be in colour) I would like to receive the newsletter by regular mail (Note: Will be in black & white)

COAA Membership Packages
Enter Quantity:	Description	Price
	General Membership Package	$35.00
	Couples Membership	$45.00
	Promoted Artists' GalleryPackage	$60.00
	Members' Gallery Package	$10.00
	TOTAL
* Image Code:

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