COLORADO POTTERS GUILD MEMBERSHIP APPLICATION 2007 - 2008

Name ____________________________________________ Date of Birth _____________________

Address (mailing) ___________________________________________________________________

Address (home) ____________________________________________________________________

Telephones:  Home ________________________

                        Work _________________________

                        Cell __________________________

                        Fax __________________________

Email address: _____________________________________________________________________

Occupation: __________________________  Employer: ____________________________________

Marital  Status:  single_____  married _____ widowed _____ divorced ______
If married, please give spouse's name

Education:

Highest grade completed: ________   Degree:_______________  Yr Received: __________
                     Major: ___________________________   Minor: ________________________________

                    Institution: _______________________________________________________________

POTTERY EXPERIENCE & EDUCATION     Number of years potting ______________________
Level of Proficiency:         Beginner ______      Intermediate ______    Advanced ______

NAMES OF INSTRUCTORS, FACILITIES
    Date(s)        Where                                   Instructor                                     Topic of Class/Workshop

1.

2.

3.

4.

5.

SHOWS ENTERED:

AWARDS RECEIVED:

GALLERIES:

HOME STUDIO?  No _____   Yes _____
  Describe your space and equipment.

ANTICIPATED USE OF GUILD FACILITIES:  Describe activities, amount of time, time of day and equipment you plan to use at the Guild.

HOW DID YOU HEAR ABOUT THE GUILD/this opening?

SPECIAL INTEREST RELATED TO POTTERY:

DESCRIBE YOUR GOALS RELATED TO GUILD MEMBERSHIP:

DESCRIBE ANY SPECIAL CONRIBUTIONS YOU WOULD BRING TO THE GUILD (e.g. skills, traits, knowledge you would share related to pottery or operation of the Guild or shows, computer skills, other skills)

DESCRIBE YOURSELF & COMMENT ON HOW YOU TEND TO PARTICIPATE IN GROUPS:

TELL US MORE ABOUT YOURSELF: (Anything!  Use back of sheet if you need more space.)

REFERENCES:
Please list names of pottery instructors and dates for each place in which you have trained or worked in the last five years:

Provide NAME, ADDRESS & PHONE NUMBERS for each reference.   Include one personal reference (not related to you)
1.

2.

3.

4.

5.

ADDITIONAL COMMENTS OR QUESTIONS:

Signature ___________________________________________   Date _______________________

PLEASE RETURN APPLICATION TO

Marta Rodeheffer, Membership Chair
29029 Upper Bear Creek Road, Suite 305
Evergreen, CO 80439

(303) 670-1864
email: martarodeheffer@msn.com