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2. Performer or Band Name*
4. First Name*
5. Last Name*
7. Title*
   What is your relationship with the performer/band, i.e. booking agent, member of the band, etc?
9. Phone Number*
10. Email*
12. Address*
14. City*
15. State*
16. Zip Code*
18. Website
19. Facebook Address
21. YouTube or other Video Address
23. Type of Entertainment*

    1. Children's
    2. Dance
    3. Magic
    4. Music
    5. Strolling
    6. Other
25. If other, please explain.
27. Please provide two professional references:
29. Please add any additional information:
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field