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Making The Artivist® Interest Form

Thank you for your interest in the Making the Artivist® program! Please fill out the form below so we can learn more about you and your interests.

Personal Information

Name *

First Name

Last Name

Email *

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Phone *

Age *

Address *

Address Line 1

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City

State/Province

ZIP/Postal Code

Country

How did you hear about the program? *

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Website

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Friend or Family

School/University

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Why are you interested in the Making the Artivist® program? What do you hope to accomplish? *