FESTIVAL DAY ARTIST PARTICIPATION FORM

Festival Day: Jungle Art -- Friday May 2, 2014

**Form must be returned to ACT by Monday, March 17!**
MAIL: ACT; 1140 Monroe Ave, Ste 4101; Grand Rapids, MI 49503

PHONE: 616-885-5866

FAX: 616-885-5867

Name ___________________________________________ Phone (Home/Cell) ___________________________________

Address _________________________________________ Phone (Work) _______________________________________
________________________________________________ E-mail: _____________________________________________
Please describe the art discipline(s) and media that apply to your area of expertise (Painting, Vocal Music, Creative Movement,
etc.). If you have a specific idea for a workshop activity, please outline it here:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Festival Day workshops run from 10:05 am to 1:20 pm. (Each session is 40 minutes). Please check which workshops your
organization would like to participate in:

All day
Workshop 1:
Workshop 2:
Workshop 3:
Workshop 4:

10:05-10:45 am
11:00-11:40 am
11:50-12:30 pm
12:40-1:20 pm

Maximum number of participants for your workshop activity? ________________________________________________

List any disability group that would not be appropriate for your workshop activity, or with whom you would prefer not to
work:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Describe physical facility needed for activity (amount of space, sink, etc): _______________________________________
___________________________________________________________________________________________________
Are there any supplies or materials that you would like ACT to provide? (ACT will make every effort to accommodate your
request and will contact you if we are unable to provide something):
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Cost: ACT does have some funding available to offset the cost of the supplies for your participation in this program. Please let
us know if you have a fee or estimated supply cost for participating in this event:
Fee: _________________
Questions? Please contact Becky at #616-885-5866 or at coordinator@artistscreatingtogether.org