VSA arts FESTIVAL DAY ARTIST'S PARTICIPATION FORM

Festival Day Friday May 4, 2012 Hand in Hand With Art

Please return this form ASAP to:

VSA Michigan-Grand Rapids

1140 Monroe Ave NW, Ste 4101
Grand Rapids, MI 49503
PHONE: 616-885-5866

FAX: 616-885-5867

Name ____________________________________ Phone (Home) _______________________

Address __________________________________ Phone (Work) ________________________
__________________________________ E-mail: ___________________________
Please describe the arts discipline(s) and mediums that apply to your area of expertise. (Painting,
Orchestral Music, Creative Movement, etc.) If you have a specific idea for a workshop activity, outline it
here.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
The Festival runs from 9:00 am. To 1:30 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
12:40-1:30 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 VSA to provide:____________________
(VSA will make every effort to accommodate your request and will contact you if we are inable to
provide something).
Cost: VSA 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 #885-5866 or at vsaadmin@iserv.net.