P&P Feature Survey

Cracked Walnut

Poets & Pints - Feature Survey

* Indicates required field

Name *

First

Last

Stage Name (if applicable) *

Phone Number (not required) *

City & State (abbv) of residence *

How did you hear about our show originally? *

Word of Mouth or Friend Facebook Cracked Walnut Website Other

If Other please specify: *

Email *

Are you a person of color or an Indigenous Person? (we seek to have diversity, in every show, if we can) *

Yes No

What is your age? (must be over 21 for Poets & Pints) *

21-28 28-35 36-50 50+

Gender or Preferred Pronoun *

Female Male Other (please tell us in the box below)

Other (preferred pronoun) *

WEBSITE? (Type "NONE" if none) *

FACEBOOK? (Type "NONE" if none) *

TWITTER? (Type "NONE" if none) *

INSTAGRAM? (Type "NONE" if none) *

YouTube Link of you performing (Type "NONE" if none) *

Describe some themes covered in your writing? *

Artist's Bio - Please write a little bio about yourself *

What is the best way to contact you? *

Facebook Messenger Email Phone Other (fill in below)

Other (if applicable) *

Submit

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