The Art House Membership

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The Art House Membership Which membership would you like to sign up for? Package A (12 Months 25 per year/ 18.50 concession) Package B (12 Months Membership 45/ 30 concession) Payment type Online transfer Cash in [person at The Art House Cheque (made payable to The Creative Art House) Member's details Your details Fill out details. Please note: *indicates a required field First name Surname name Address Postcode Landline telephone no. Mobile telephone no. Email address

E Bulletin and Artists Opportunities Newsletter We will send this to you by email. However, if you would prefer to receive this in an alternate format, please select your preferred format here: Hard copy by post Large print format by post Audio Bulletin If you require information in another format, please do not hesitate to contact us. Members Area on The Art House website As a member of The Art House you will be able to access professional development resources and communicate with other artists on the members area of our website. Artist Profile You are also entitled to an Artist Profile which can access and update yourself at any time. The information in this form will be used to create an Artist Profile for you on our website. Please tick this box to confirm that you would like to have an Artists Profile on our website. I DO wish to have an Artist Profile I do NOT wish to have an Artist Profile

Members Area login Login details (you can change and update this information by logging into your account at any time) User name Password Please keep a note of your Username and Password. You will need it to log into the Members section of the new website. Artist Statement Please complete in the box below or online when you access your profile on the AH website.

Your Profile Images The new website will allow you to upload images to your profile. We recommend you use images of your work, rather than of yourself. PLEASE ADD AT LEAST ONE IMAGE THE FIRST TIME YOU ACCESS YOUR ONLINE PROFILE Artforms & interests Artforms Which artforms do you work in? - (please tick all that apply) 2D 3D Animation Architecture Basketry Ceramics Craft Design Digital Drawing Education Etching Film and Video Fine Art Furniture Glass Graphics Jewellery Live Art Metalwork Mixed Media Painting Participatory Art Performance Photography Printmaking Public Art Publication Sculpture Sound Text Textiles Woodwork Illustration

Areas of Interest Please select your areas of interest - (select all that apply) Select all Art House Friends & Supporters schemes Artists Opportunities Exhibitions Funding and Bursaries Networking Print Studio Facilities Professional Development and Mentoring Residencies Studios and Creative Spaces to Hire Vacancies Volunteering Opportunities Workshops and Courses

Equal Opportunities Monitoring Please note. This section is voluntary. However, it is important to us to know how our membership is made up. We will use this information in the following ways: To ensure that we offer the best service possible to our members and maintain good practice. To enable us to provide statistics about the make-up of our membership to funding bodies. A copy of The Art House s Equal Opportunities Policy is available on request. Please tick: I give my consent for the information I give to be used as described above, in accordance with the Data Protection Act 1998. Age What is your age? Under 20 20-24 25-29 30-34 35-39 40-44 44-49 50-54 55-59 60-64 65 and over Prefer not to say Residence What is your country of permanent residence? UK Other European Union / European Economic Area USA

Other Prefer not to say Ethnicity What is your ethnic group? Asian, Asian British, Asian English, Asian Scottish or Asian Welsh Bangladeshi Indian Pakistani Any other Asian background please specify: Black, Black British, Black English, Black Scottish or Black Welsh African Caribbean Any other Black background please specify: Mixed White and Asian White and Black African White and Black Caribbean Any other Mixed background please specify: White British English British Scottish British - Welsh Irish Any other White background please specify:

Chinese / Middle Eastern/ Other ethnic background Chinese Middle Eastern/ North African Any other background please specify: Prefer not to say Do you consider yourself to be disabled/ have a life-limiting illness? Yes No Prefer not to say If you answered YES above please give details: Blind / partially sighted/ visually-impaired Deaf / hearing-impaired Learning Difficulties Dyslexia Mental Health Difficulties Personal Care Support Unseen disability (eg diabetes, epilepsy, asthma) Wheelchair user/ mobility issues 2 or more of the above Thank you You will receive instructions on how to access the Members Area of the new website once your membership has been processed.