Exit this survey Medford Health Matters Switch Box Project The purpose of this form is to help the planning committee match adults and youth artists (no previous artistic talent/experience is required to participate). Your responses will help the planning committee best make use of your time and interests. Please be as specific and honest as possible. Students will receive Community Service Hours. Thank you, Medford Health Matters Switch Box Committee Question Title * 1. Are you: Adult Student Question Title * 2. Are you male or female? Male Female Question Title * 3. Please provide contact information Name: Address: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Email Address: Question Title * 4. If applicable, school attending: Question Title * 5. We know that schedules are subject to change we are looking for general availability. Please circle all potential availability. Weekdays Weekdays Weekdays Weekdays Weekdays Weeknights Weeknights Weeknights Weeknights Weeknights Weekend Days Weekend Days Weekend Days Weekend Days Weekend Days Weekend Nights Weekend Nights Weekend Nights Weekend Nights Weekend Nights Done