Affiliate Member Form
(Pay By Check)

Affiliate Form
(Pay By Check)

Affiliate Members are organizations, and or businesses who support the mission and values of AFHS-M, Inc., and support the role that the arts can have in promoting health and wellness. An Affiliate does not provide the services of arts and health as their main focus/service, but strongly support arts and health integration in our community.
PLEASE FILL OUT ALL REQUIRED FIELDS.

Essential Info

Please send check in the amount of $30.00 to this address and write invoice number on check in the memo section.

Arts For Health Sarasota-Manatee
7727A Holiday Drive
Sarasota, Fl. 34231
First and Last name or Company name
Best describes yourself or business
In the Location (address) field, if your location (address) is a private residence and wish not to have address listed in directory, then please just type in your city and zip.
If you would like to leave your private mailing address type it here. It will not be shown in the the directory.

Contact Info

http(s)://example.com or http(s)://www.example.com

Social Accounts

Integration Work

Your arts and health integration work.
Primary Art Form(s) used in Arts and Health Integration Work.
Drop a file here or click to upload Choose File
Maximum upload size: 2.1MB
A profile picture is required, this can be your profile picture or business logo.
When uploading a new photo:
1.) Upload new photo
2.) Uncheck the old photo
3.) Then click on Submit button
Sending