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* 1. Name (last name, first name):

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* 2. Street Address:

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* 3. City, State, Zip:

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* 4. Daytime Phone:

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* 5. Evening Phone:

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* 6. Cell Phone:

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* 7. Email Address:

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* 8. Where are you employed:

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* 9. If you ARE a theatre or arts professional, are you (choose all that apply to you):

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* 10. If you ARE NOT a theatre or arts professional, are you (choose all that apply):

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* 11. What formal theatre education do you have (if any)?

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* 12. What is your professional theatre experience (if any)?

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* 13. How long have you lived in the Tampa Bay area?

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* 14. How long have you been a participant (either as an artist or audience member) in Tampa Bay theatre?

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* 15. Do you currently have or have previously had a direct PROFESSIONAL connection (employee, contractor, board member, etc.) with any Tampa Bay area constituent theatre?

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* 16. Do you currently have or have you previously been a FINANCIAL SUPPORTER (donor, subscriber, etc.) of any Tampa Bay area constituent theatre?

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* 17. If you answered yes to Question 15 or 16, please check all theatres with whom you currently or previously have had any association other than as an audience member.

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* 18. Please indicate the nature of those associations (e.g. donor, member of acting company, former employee etc.)

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* 19. If you are empaneled as a judge, please indicagte which theatres you feel you should be excluded from judging due to conflict of interest. Please note your name will also be vetted with the leadership of all theatres to determine their percieved conflict of interest.

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* 20. Do you have any potential time constraints or transportation limitations?

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* 21. Please indicate all theatre(s) you have attended in the last 12 months.

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* 22. Please list the last five Tampa Bay area productions (plays/musicals) you have attended (production, theatre, approximate attendance date).

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* 23. Of the five productions listed, articulate:

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* 24. Of the five productions listed, articulate:

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* 25. Please articulate why you believe that you would make a good Jeff Norton Awards judge:

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* 26. While helpful, but not mandatory – can a member of the artistic staff of a Jeff Noton Awards eligible theatre offer a recommendation regarding your qualifications to serve as a judge?

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* 27. If so, please provide the name(s), affiliation(s), and email address(es) of those references.

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