* Required Fields
Name of Organization:
(if any)
Use my Organization
or
Personal
name in Profile Lists.
* First Name:
* Last Name:
* Address:
* City:
* Region: What's this?
Please select a region
Statewide
Metro Area
Southwestern
Southeastern
Central
West Central
Northwestern
Northeastern
Outside Minnesota
* State/Province:
AB - Alberta
AK - Alaska
AL - Alabama
AR - Arkansas
AZ - Arizona
BC - British Columbia
CA - California
CO - Colorado
CT - Connecticut
DC - District of Columbia
DE - Delaware
FL - Florida
GA - Georgia
HI - Hawaii
IA - Iowa
ID - Idaho
IL - Illinois
IN - Indiana
KS - Kansas
KY - Kentucky
LA - Louisiana
MA - Massachusetts
MB - Manitoba
MD - Maryland
ME - Maine
MI - Michigan
MN - Minnesota
MO - Missouri
MS - Mississippi
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
VA - Virginia
VT - Vermont
WA - Washington
WI - Wisconsin
WV - West Virginia
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:
Performing Arts - Comedy
Performing Arts - Dance
Performing Arts - Music-Vocal
Performing Arts - Music-Instumental
Performing Arts - Spoken Word
Performing Arts - Theatre
Performing Arts - Other Performing Arts
Literary Arts - Fiction
Literary Arts - Non-Fiction
Literary Arts - Playwriting
Literary Arts - Poetry
Literary Arts - Other Literary Arts
Visual Arts - Ceramics
Visual Arts - Crafts
Visual Arts - Collage
Visual Arts - Drawing
Visual Arts - Film/Video
Visual Arts - Jewelry
Visual Arts - Digital Media
Visual Arts - Mosaic
Visual Arts - Painting
Visual Arts - Photography
Visual Arts - Printmaking
Visual Arts - Sculpture
Visual Arts - Weaving/Fiber
Visual Arts - Woodworking
Visual Arts - Mixed Media
Visual Arts - 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 Areas What's this?
Statewide
Metro Area
Southwestern
Southeastern
Central
West Central
Northwestern
Northeastern
Outside Minnesota
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).
Photos.
Please provide 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.
Format specifications: JPG, preferably no bigger than 600 x 600 pixels, 72 ppi resolution. Image files should not be larger than 1 MB.
For each photo, click on the Browse (or Choose File ) button to select an image file, and optionally enter a caption of up to 100 words (500 characters).
Photo 1
File:
Caption:
Photo 2
File:
Caption:
Photo 3
File:
Caption:
Photo 4
File:
Caption:
Yes. I want to receive news about arts and aging from MnCAAN.
No. Do not send me news.
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