Healing Connections Open Mic Interest Form

Please fill in your information below if you are interested in attending or performing at the event so we can stay in touch.

Thank you!

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* 1. Are you interested in performing at the open mic? If yes or unsure, please complete the rest of the survey. If not, you have successfully completed the survey and can skip the following questions.

Yes

Unsure

No - interested in attending only

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* 2. What is your first name, last name and artist name (if applicable)?

First name

Last name

Artist name

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* 3. What is your email address? Will be used to contact you regarding the event.

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* 4. What is your performance art piece? Ex: poetry, spoken word, dance, music, etc.

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* 5. Please provide an example of your intended performance art, either through an attachment (e.g. YouTube link, Word Doc, etc.) or an emailed copy to Tia Bell at tbell1@smcgov.org.