Complete this form and enclose your check for $40.00 annual membership dues.

If the date is between January 1 and May 31, half year fees are $20.00.

Make your check payable to the Dayton Society of Painters and Sculptors.

Send both the application and fee to:

Darcy Morgan, Membership Chair

1295 Colson Court

Miamisburg, OH 45342

PLEASE TYPE OR PRINT

Full Name ___________________________________________________________________________

Home Address ________________________________________________________________________

City, State and Zip Code ________________________________________________________________

Phone Number - including area code _______________________________________________________

E-mail address ________________________________________________________________________

Art education _________________________________________________________________________

_____________________________________________________________________________________

Awards and honors _____________________________________________________________________

_____________________________________________________________________________________

Medium(s) ___________________________________________________________________________

Subject matter(s) ______________________________________________________________________

Do you teach? _________________

Sponsor, a DSPS member who encouraged you to join: _______________________________________

This person will receive a free entry to a DSPS Juried Show.

We depend on members to volunteer for activities in the Society.

Please indicate your willingness to help:

Help a committee_____ Gallery sitting______ Hospitality/cookies for meetings______ Newsletter _____

Property ______ Help with shows_______ Website _______