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2. Date
   Date
4. Name of Act
6. I am / We are:

   1. Band
   2. Choir
   3. Comedian

   1. Solo/Duo or Singer/Musician
   2. Character (Santa, Cinderella, etc.)
   3. Other
8. First Name
9. Last Name
11. Address
13. City
14. State
15. Zip Code
17. Phone
18. Email
20. Act Website / Facebook Page
22. Stage Plot (if necessary)
23. Rate or Pay (if any)
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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit Submit and Print

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