Jazz Power Community Workshop

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please fill in this brief survey to sign up to our Jazz Power Community Workshop.

1. Full Name *

2. Street Address *

3. Zip Code *

4. Email *

5. Mobile Number

6. What experience do you have as an artist? *

I am a beginner instrumentalist/singer

I am a mid-career instrumentalist/singer

I am an experienced instrumentalist/singer

I am not an instrumentalist/singer

Other:

7. What organization(s) are you affiliated with? *

8. What do you expect to receive from Jazz Power Community Workshop? *

9. How did you hear about Jazz Power Community Workshop? *

At an in-person event

Jazz Power Initiative's social media ad

A friend/colleague

An email/newsletter

10. Do you know any children 10-18 who could benefit from our youth arts education programs? *

Yes (send suggestion to arlene@jazzpower.org)

11. How old are you? *

16-25

26-35

36-45

46-55

56-65

65+

I prefer not to answer

13. (OPTIONAL) How do you identify yourself? Check all that apply

Hispanic or Latino

Black or African American

Native American or American Indian

Asian or Pacific Islander

White or Caucasian

Other:

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Jazz Power Initiative.

Does this form look suspicious? Report