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Please provide us with the following information.

Name*
Organization
Title or Position*
Phone Number*
Email Address*
Event Name
Event Date & Time

MM		/
DD		/
YYYY
HH		:
MM
AM/PM
Event Description*
Anticipated Attendance*
Target Age Group*
Is the event public or private?*
Is the event free?*
Venue Name
Venue Address
Venue Capacity
Venue Description
Concert Hall 
Park 
Sanctuary 
Other 
Gym 
Venue Stage
Square Stage 
Gym 
Church Pulpit 
Other 
Walkway Stage 
How will the event be promoted?*
Radio 
TV 
Flyers 
Email Blast 
Word of Mouth 
Other 
Will the event host or the artist provide lodging?*
Will the event host or the artist provide travel
expenses?*
What is your compensation offer for ILL PHIL?*
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