* Required Fields
Name of Organization:
(if any)
Check this box to use your Organization as your Profile Listing name.
* First Name:
* Last Name:
* Address:
* City:
* Region: What's this?
Please Select
Outside Minnesota
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METRO AREA
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SOUTHEAST
CENTRAL
WEST CENTRAL
NORTHEAST
NORTHWEST
* State/Province:
Other - Not listed
AB - Alberta
AL - Alabama
AK - Alaska
AR - Arkansas
AZ - Arizona
BC - British Columbia
CA - California
CO - Colorado
CT - Connecticut
DE - Delaware
DC - District of Columbia
FL - Florida
GA - Georgia
HI - Hawaii
ID - Idaho
IL - Illinois
IN - Indiana
IA - Iowa
KS - Kansas
KY - Kentucky
LA - Louisiana
MB - Manitoba
ME - Maine
MD - Maryland
MA - Massachusetts
MI - Michigan
MN - Minnesota
MS - Mississippi
MO - Missouri
MT - Montana
NB - New Brunswick
NC - North Carolina
ND - North Dakota
NE - Nebraska
NF - Newfoundland
NH - New Hampshire
NJ - New Jersey
NM - New Mexico
NS - Nova Scotia
NT - Northwest Territories
NU - Nunavut
NV - Nevada
NY - New York
OH - Ohio
OK - Oklahoma
ON - Ontario
OR - Oregon
PA - Pennsylvania
PE - Prince Edward Island
PR - Puerto Rico
QC - Quebec
RI - Rhode Island
SC - South Carolina
SD - South Dakota
SK - Saskatchewan
TN - Tennessee
TX - Texas
UT - Utah
VT - Vermont
VA - Virginia
WA - Washington
WV - West Virginia
WI - Wisconsin
WY - Wyoming
YT - Yukon
* Zip/Postal Code:
* Country:
Phone (w Area Code):
Fax (w Area Code):
* E-mail:
Website:
Social Network URLs:
(for example: Facebook, YouTube, MySpace, Twitter, 2nd Life, Flickr, LinkedIn, etc.)
* Your primary artistic discipline:
Please Select
Comedy
Dance
Music-Vocal
Music-Instumental
Spoken Word
Theatre
Other Performing Arts
Fiction
Non-Fiction
Playwriting
Poetry
Other Literary Arts
Ceramics
Crafts
Collage
Drawing
Film/Video
Jewelry
Digital Media
Mosaic
Painting
Photography
Printmaking
Sculpture
Weaving/Fiber
Woodworking
Mixed Media
Other Visual Arts
Other artistic disciplines (Check all that apply):
* Provide your bio or a profile of your organization, describing your artistic work and background. Also tell us about your experience and interest in engaging older adults as students, participants, or audience. Limit 500 words (2500 characters).
Awards & Special
Accomplishments
Limit 100 words
(500 characters).
* List types of activities or products you offer, such as performances, classes, exhibits, or presentations. You may include names and brief descriptions of specific offerings. Limit 200 words (1000 characters).
* Your availability to bring what you offer to locations where older adults live or gather:
Can you travel to an organization? Yes No
Travel Area What's this?
STATEWIDE
METRO AREA
SOUTHWEST
SOUTHEAST
CENTRAL
WEST CENTRAL
NORTHEAST
NORTHWEST
Travel Limitations (if any):
Limit 100 words
(500 characters).
Times Available
Limit 100 words
(500 characters).
* Fee or fee range for your services or products. Include such items as materials fees and travel reimbursement. Limit 250 words (1250 characters).
Please send 1-4 photos showing you, your artistic activities, or your clientele participating in activities. Photo 1 should be your primary image, such as a portrtait of yourself. After submitting this form you will be given an email address to send your images.
Format specifications: JPG, no bigger than 600 x 600 pixels, 72 ppi resolution
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