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2. First Name*
3. Last Name*
5. Address1
7. Address2
9. City
10. State
11. Zip
13. Email address*
14. Daytime Phone Number*
16. Why are you interested in serving on a public art selection committee?*
    Please limit your answer to 1000 characters.
18. Please list any past or present volunteer positions you have held with the City or local non-profit agencies.
20. Arts Interests

    Please check all that apply.

    1. Art in parks
    2. Art at public buildings
    3. Art on streets
    4. Art in Downtown Dublin
    5. Temporary art installations
21. Availability

    Please check all that apply.

    1. Weekday mornings
    2. Weekday lunch hours
    3. Weekday afternoons
    4. Weekday evenings
    5. Weekend mornings
    6. Weekend afternoons
22. About You

    Please check all that apply.

    1. I am a Dublin resident.
    2. I am a Dublin business owner.
    3. I am an older adult, age 60 or older.
    4. I am a young adult, age 30 or younger.
    5. I have a child in Dublin schools.
    6. I am an artist.
24. Is there anything else you would like to share?
    Please feel free list any other information that might help us to assemble diverse public art committees. For example, you may wish to let us know your ethnic background or if you have any unique life experiences that give you a different perspective on public art, such as being a wheelchair user.
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26. 1. Receive an email copy of this form.
27. Email address

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28. Submit

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