Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Personal Background

What skills or education could you contribute? Please check all that apply

Accounting

Budget

Fundraising

Marketing

Planning

Special Events

Legal

Lobbying

Management

Public Speaking

Community Events

Education

Other

Artistic Background

What is your artist practice or background?

Visual Arts

Literary Arts

Performing Arts

Multimedia Arts

Other

Your ability to serve

Can you regularly attend board meetings held once a month in person or via Zoom:

Yes

No

Would you be willing to chair a committee?

Yes

No