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Please provide the following contact information: 
* Indicates a required field to establish your membership and participation. 
     By sending the form you are agreeing to be featured in the StoneWall Society GLBTI Artists Promotion directory and featured on the StoneWall Society website.

First Name*
Last Name*
Street Address
Address (cont.)
City*
State/Province*
Zip/Postal Code*
Country*
Home Phone
FAX
E-mail*
URL http://

Enter your art form/forms in the space provided below. Examples: Music, theatre, dance, literature, etc.*

Please enter your professional / performance name below. Such as band name, pen name.

Review request.

I am submitting material via email. I am submitting via postal service or other land delivery. I am requesting an Online review of my art. I am not submitting material.

Permissions, please check the appropriate boxes.

I give permission for my music to be added to StoneWall Society Internet radio Rainbow World Music and artist directory.

I give permission for StoneWall Society to add links to my art in promotional areas suitable to my specific art. You will be notified by StoneWall Society for individual approval for each listing. Examples would be MP3.com and like services.

I give permission for my visual art images to be used in review of my works in the StoneWall Society GLBTI Artists promotion.

I give StoneWall Society permission to use excerpts from my material, with credit, in reviews of my works and in promotional areas of the StoneWall Society site which would direct visitors to my works. 

Further description of the art form/forms with which you identify. 

Are you interested in being a member of the board of advisors to assist in directing the promotion focus on specific goals?

Yes
No
Maybe

I am most interested in participating in: Select any of the following options that apply:

Promotional opportunities for Artists
Support of Artists Opportunities
Membership/Participant committee
StoneWall Society awards committee

Please provide a self statement for your member/participant profile.

Additional thoughts you wish to send us.