Becoming a member of the Brantford Arts Block

Thanks for becoming a member of the Brantford Arts Block. The Brantford Arts Block is a member driven organization and your support is greatly appreciated.

For details on the benefits of becoming a member, click here.

General Membership

Thank you for supporting the Brantford Arts Block as a new member!

	General Membership - $ 25.00
	Student Membership - $ 15.00
	Family Membership - $ 40.00

	I will send payment by check
Email Address *	I am contributing on behalf of an organization.

Organization Details

Organization Name

Primary Phone
Primary Email
Street Address	Street number, street name, apartment/unit/suite - OR P.O. box
Addt'l Address 1	Supplemental address info, e.g. c/o, department name, building name, etc.
Addt'l Address 2
City
Zip / Postal Code	- Enter optional 'add-on' code after the dash ('plus 4' code for U.S. addresses).
Country
State / Province

Please enter a user name to create an account. If you already have an account, please login before completing this form.

Username *	Your preferred username; punctuation is not allowed except for periods, hyphens, and underscores.
Password
Confirm Password	Provide a password for the new account in both fields.

Name and Address

First Name *
Last Name *	First and last name will be shared with other visitors to the site.
Street Address (Home) *
City (Home) *
Postal Code (Home) *
Country (Home) *
Province (Home) *
Phone-Phone (Home) *

Thanks again for your support, it's greatly appreciated!

Becoming a member of the Brantford Arts Block

Login Form