First Name:*
Last Name:*
Age:*
Date of Birth:* (mm/dd/yyyy)
Address Line 1:*
Address Line 2:
City:*
State:*		Please Choose AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip/Postal Code:*
Telephone:*
Tell us a bit about yourself!
Where were you born?
What are your hobbies?
What is your favorite book?
What is your favorite movie?
Who is your favorite singer?
What are some important things that have happened in your life so far?
What do you want people to know about you?
Describe an average day in your life:
Have you used art to help you through difficult times? If so, how?
Tell us why you like art!
When do you like to do art?
Do you like to create art when you are feeling happy? Sad?
Are there any colors, materials, or styles you like to use when you create art?
Share A Picture of Yourself!
Please attach a photograph of yourself so we can put it on your Artist of the Month page:
Consent to Use Information and Photo:
Parent/Guardian's Name (or own name if 18 & over)
Please read the following paragraph and provide your initials verify your consent:
I agree to allow ArtWorks to release the information provided on this form (including but not limited to the biography, name, age) and my photograph to be used in ArtWorks publications including but not limited to ArtWorks journal and/or on ArtWorks website and/or presentation at an ArtWorks exhibition, fundraising event and/or any other ArtWorks materials all in the sole and absolute discrection of ArtWorks. I agree to Allow ArtWorks to release the information and photograph provided in this form to other organizations and their publications and to the media such as but not limited to newspapers, entertainment or other print media.
Please initial below to acknowledge that the use of the information and photograph thereto are being carried out with your full consent: