*Denotes required field.

*Name:

Title:

Organization:

*Address:

*City:

*State:

*ZIP:

*Phone Number:

E-mail Address:

Website:

*Optional $10 box lunch:

Box Lunch

Vegetarian Box Lunch

No Box Lunch

Note: If you select a box lunch, payment will not be accepted at the event. Please mail $10 in advance (check payable to the Kansas Arts Comission) by Friday, February 27 to:

ATTN: Leslie
Kansas Arts Commission
700 SW Jackson, Suite 1004
Topeka, KS 66603-3774

*Are you planning to attend the Kansas Artist Fellowships and Awards Reception following the symposium?:

Yes

No