Please enable JavaScript in your browser to complete this form.Name *FirstLastAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *Please list your education background.Please list any appointed public boards, commissions, or committees on which you have served, dates of service, and any chairmanship or office held. Please list any organizations of which you are a member and any offices you have held in those organizationsHow do you believe your experience (personal, educational, professional) will apply by serving on the Arts Council? If so, please explain:Do you have any personal goals or objectives that might be achieved by serving on this Council? If so, please explain:References (optional):Please list name, organization, phone numberAdditional CommentsParticipation Waiver "I, the undersigned, acknowledge that this form, once it is submitted, is a public record and as such, the City of Selma will disclose the fact that it was filed and its contents upon receiving the appropriate request. By signing this form and submitting it to the City of Selma I hereby forever waive any claim of confidentiality and any claim of privacy which I may otherwise have in the content of this document and in the fact that it was filed with the City of Selma. I understand that this information is NOT CONFIDENTIAL in any way.” **Those convicted of a felony or registered as a sex offender will not be permitted to participate or volunteer for the Selma Arts Center** By Signing I verify that I have read and understand this condition to audition/volunteer. SignatureClear SignatureSubmit