Student Sign-Up – Elko County Art Club

Student Membership

Date *

Membership *

Student Name *

First

Last

Nickname

Student Phone

Student Email

What school do you attend? *

What year/grade? *

Tell us a little about yourself. What kind of art do you like to do? What kind if art would you like to do? Anything else?

Name *

First

Last

Phone *

Email *

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Questions/Concerns

Can we email you information about the Gallery, upcoming art competitions, exhibits and local artists, and member benefits? *