Name of Applicant (artist or collective / company name) (required) :

Your Email (required) :

Phone (required) :

Date of Birth (required) :

Primary Contact (if applicant is a collective / company name) (required) :

Web Site:

Facebook:

Twitter:

Instagram:

Proposed Event Admission Cost (if Applicable) (required):

Event Date (Proposed Date) (required) :

Event Time (Start Time / End Time) (required) :

Event Set Up Time:

Event Clean Up Time:

Event Purpose (required) :

Event Description (up to 350 words) (required) :

Talent (ie. Visual Artists, Musicians, Performers, DJs, Bands, etc.) (required) :

Event Projected Attendance (required):

Event Security Provided (required):