Cultural Facility / Venue Application
For Arts:Earth Partnership

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For printable .PDF version (for mail or faxing application) please click here.

Thank you for joining Arts:Earth Partnership. With this commitment your organization is making a bold step toward achieving environmental sustainability. We welcome you to the collective.

Venue:
Type(s):	Theater or PAC   Dance Studio   Gallery   Museum   Other:
Street:
City:		State:	ZIP:
Phone:		Fax:
Web Address:
AEP Contact Person:		Title:
Email:
Is venue 501(c)3 exempt?:	Yes No	What year was organization established?

Facts About Your Space:

(use approx. sq. footage)

Does your organization currently recycle solid waste?			Yes No	Do you vend food or drinks?	Yes No
Overall square footage:		On-Site Parking:	Yes No	No. of Spaces
Theater Space
No. of Theaters:		Seats:	//	Sq. Footage:	//
Gallery Space
No. of Rooms:		Sq. Footage:	////
Studio Space
No. of Studios:		Sq. Footage:	///
Lobby Space
Lobby Space:	Yes No	Sq. Footage:	/
Rehearsal / Classroom(s)
No. of rooms:		Sq. Footage:	///
Private Rooms
Number of private rooms: (offices, dressing rooms)		Sq. Footage:	///
Please provide general description of your space or point us to the URL:
How many (approx) visitors per year?
Would you consider your venue as a host for an annual meeting or partnership event?			Yes No
(optional) Please briefly describe why your organization wishes to commit to participation in AEP. (All information provided here, except venue name for purposes of member roster, will be held in strict confidence).

Our 2 Year Certification Fee is based on square footage, as described below:

	2,000 sq. feet and below	$200
	2,000 - 5,000 sq. feet:	$300
	5,000 - 10,000 sq. feet:	$400
	Above 10,000 sq. feet:	Please call. (310) 306-1854

Email Address:
Desired Password:	Used to access the Materials Exchange Bulletin Board

Billing Information

Billing First Name:
Billing Middle Name:
Billing Last Name:
Billing Street Address:
City:
State:		ZIP:
Country:
	I will send payment by check Santa Monica based facilities and artists will receive a rebate, equal to your first of the 2 year fee, within 2 months of your payment. This rebate is a subsidy from the City of Santa Monica. If paying by credit card, after clicking Submit Form below, please proceed to PayPal to make your payment

Total:

Arts:Earth Partnership
C/O Electric Lodge
1416 Electric Avenue
Venice, CA. 90291
FAX to: (310) 306-1117

Make checks payable to: Electric Lodge and print "AEP" in the memo line.

Arts:Earth Partnership fully respects your privacy. AEP will not sell, trade or reveal your information without your consent. We will list you as a member.