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Jazz Girls Day Educator Registration Form
Basic Information
Name
*
First
Last
Gender
Female
Male
Non-binary
Other
Prefer not to say
Optional…would you prefer to display your pronouns on the JGD name tags?
no preference, please don't display pronouns
she/her/hers
he/him/his
they/them/theirs
ze/zir/zirs
I'd prefer a different pronoun set and will provide them in the next field
Other optional pronoun choice
Please provide your preferred pronoun set if not listed on the previous field
Position
*
School District
School Name
*
Instrument
*
includes voice
Email
*
Primary Phone
*
Secondary Phone
Mailing Address
Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
County
*
Please tell us the county in Ohio in which you reside.
Jazz Experience
*
Please select
Little to none
Played in school
Professional level
Shirt size
S
M
L
XL
XXL
JGD shirts will be available for purchase on site. This will help us get an estimate of how many to order.
Releases and Permissions
Photo Release
*
I understand that there will be occasions that photos and videos are taken of the Jazz Girls Day and its participants for promotional and documentation purposes, and by signing the application form, furnish permission for my likeness to be used for the above-mentioned purpose.
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