Town of
Nomination Form
Date: _______________
Name of artist nominated: ___________________________________________________________
Artistic field/craft (offer area, or areas, that seem appropriate): ______________________________
_________________________________________________________________________________
Date of Birth (if known): ____________________________________________________________
Place of Birth (if known): ___________________________________________________________
Dates artist has been active in
Residence(s) while active in
________________________________________________________________________________
Name of person making nomination: ___________________________________________________
Phone number and/or e-mail of person making nomination: _________________________________
Address of person making nomination: _________________________________________________
In order to make this nomination as complete as possible, please
attach a description detailing the nature of the artist’s/craftsman’s work and their
association with
(Important Note: Please place artist’s name and your name on any attachments.)
For Town Historian use only:
Date received: ____________
Date added to Registry: _________