Public Art Committee Interest Form Question Title * 1. First Name OK Question Title * 2. Last Name OK Question Title * 3. Email Address. OK Question Title * 4. By providing your email address you agree to "opt in" to the Public Art email communications distributed by the City of Lee's Summit and/or the Lee's Summit Arts Council. These communications may include but are not limited to email newsletters, email blasts, or electronic invitations to public art related events. Would you also like to be added to the general Lee's Summit Arts Council email list to receive information about arts and cultural activities that take place within the City? Yes No I already receive Arts Council email communications. OK Question Title * 5. Are you interested in serving on the Public Art Committee? Yes No, I simply just want to be informed about Public Art related news at this time. Not sure yet/don't know OK Question Title * 6. If yes to Question 5, briefly describe why you would like to serve on the public art committee. List any relevant qualifications, interests or background that would benefit the committee. You do not have to be an artist or have a background in public art to serve on the committee. OK Question Title * 7. Address (to determine City Council District.) Company (if applicable) Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Phone Number OK DONE