Form Center

2. PUBLIC PERFORMANCES, SHOWS, AND EXHIBITIONS APPLICATION
4. Please Select*

   1. Annual Performance
   2. Individual Performance
6. Company*
7. Contact Person*
9. Address*
10. City*
11. State*
12. Zip Code*
14. Phone Number*
15. Email Address
17. Place of Performance*
18. Address of Performance*
20. Date(s) of Performance(s)*
    Date(s) of Performance(s)

    Date(s) of Performance(s)
21. Number of Seats
23. Type of Performance*
    -- Select One --Theatrical, Dramatic, OperaticTricks, Jugglery, Sleight-of-HandWrestling, Boxing, Sparring
24. Fee
    $5.00 for the 1st performance $4.00 for each subsequent performance *$25.00 per year for Wrestling, Boxing, Sparring Performances
26. Additional Information
30. Certification
32. Initials*
33. Date*
    Date
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit Submit and Print

* indicates a required field