DEPARTMENT OF ADMINISTRATION

OFFICE OF CULTURAL AND HERITAGE AFFAIRS

(609) 625-2776, ext. 6314
Fax: (609) 625-8143

Artist Directory Application Form

For inclusion in the Artist Directory, complete the form below and a member of the Office of Cultural and Heritage Affairs will review your information. You can also click here to print a application and mail it in if you prefer.

When your are finished click the Insert Record button.

Last Name/Organization Name:

First Name:

Middle Initial:

Professional Name (If Used):

First Name:

Middle Initial:

Last Name:

Mailing Address:

Line 1:

Line 2:

City:

State:

Zip:

Telephone Number :

List Telephone Number in the Directory?

Yes

Fax Number:

List Fax Number in the Directory? Yes

Email Address:

List eMail address in the Directory? Yes

Website Address:

List website in the Directory? Yes

Category (Literary, Performing or Visual ONLY):

Primary Artistic Discipline: indicate what best describes the primary career discipline, e.g. "painter- Abstract" "film - cinematographer" "writer - poetry". A maximum of 2 sample professional credits may be included for the published listing.

Will you be submitting an image to the directory? Yes

Image: Submit one image in digital .jpeg format. This image can be burned onto a CD or email to Cynthia Mason-Purdie at mason-purdie_cindy@aclink.org. We will scan from a photograph but will not be responsible for returning the photograph. Please write the artist name as the title of the .jpeg file or on the back of the photograph.

Image Identification: Title of work, medium, etc. of the image sent: (e.g. "mona Lisa" oil painting)

Secondary Artistic Discipline: Individual artists only - indicate here other artistic interests exclusive of primary career discipline.

Professional Associations: List up to 2 career related unions or guilds. Write out the full name. Do not use acronyms.

	Atlantic County Government DEPARTMENT OF ADMINISTRATION Office of Cultural and Heritage Affairs