Copy of MCA Arts Advocacy Day 2010 Registration Form Survey

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Copy of MCA Arts Advocacy Day 2010 Registration Form

Dear Arts Advocates: Arts Advocacy Day is coming March 2, 2010, please complete the following form to register for MCA's Arts Advocacy Day by Friday, February 26, 2010. For more information, please visit our website at www.mncitizensforthearts.org, contact us by phone at (651) 251-0868 or by email at staff@mncitizensforthearts.org.

**All information you provide on this registration form is for internal purposes at MCA only. We do not share our lists with others.

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First Name:

First Name:

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Last Name

Last Name

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Permanent Home Address:
Street:

Permanent Home Address: Street:

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City:

City:

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State:

State:

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Zip:

Zip:

Current Mailing Address (if different):

Current Mailing Address (if different):

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Email Address: (Email required! Thank you helping us reduce our mailing costs. All materials will be sent via email unless you request snail mail. If you do not have an email write NONE)

Email Address: (Email required! Thank you helping us reduce our mailing costs. All materials will be sent via email unless you request snail mail. If you do not have an email write NONE)

Daytime Phone:

Daytime Phone:

Legislative District: (If you don't know your district we would be happy to look it up for you!)

Legislative District: (If you don't know your district we would be happy to look it up for you!)

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Arts organization(s) you are affiliated with: (If none, write NONE)

Arts organization(s) you are affiliated with: (If none, write NONE)

State legislators you know personally or would like to meet that day: (We will do our best to accomodate all requests)

State legislators you know personally or would like to meet that day: (We will do our best to accomodate all requests)

Personal Accomodations: Please note any needs related to transportation, communications, interpreting or alternative format materials and we will do our best to accomodate them.

Personal Accomodations: Please note any needs related to transportation, communications, interpreting or alternative format materials and we will do our best to accomodate them.

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