Artists and Facilitators Registration Form

Arts Category Artist Arts Facilitator

Indicate your Working Status Professional: Semi-Professional: Voluntary:

Do you work: Full time: Part-time:

Contact Details First Name:
Last Name:
Address:

Telephone Number:
Mobile Number:
Fax:
e-Mail:
Website Address

Please indicate your primary discipline

Dance Choreographer: Dance Instructor Dancer/Performer: Other:

Film Filmmaker Filmmaking Facilities: Other:

Music Composer: Individual Musician: Opera: Singer/Songwriter: Other:

Drama Actor/Performer: Playwright: Street Theatre: Theatre Director: Other:

Craft Wood: Glass: Jewellery: Ceramics: Other:

Description of Work

Please give a short description or statement of own art work:

Do you hold an Arts Qualification?

If so please state type of qualification,institution and year completed:

Arts in Our Community

If you have experience of working in specific contexts such as in schools,in healthcare settings or with youth/community groups, etc. please give brief details:

I Agree to release all given information, including contact details, for publication and inclusion in Limerick County Council Arts Database and on the Limerick County Council web site.