Course Entertainment Registration Form

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Name of group/performer:
Primary contact name:
Address:
City:
State:
Zip:
Phone:
Phone (day of event):
Email:
Website:
Number of people in group:
Approximate size of space needed to perform:
Type of surface best suited:	Grass Asphalt Concrete No preference
Will you need to access electricity? If so, please describe:
What kind of identification or signage, if any, will be used?
How many times have you performed at the 500 Festival Mini-Marathon?
If you performed in 2011, what was your or your group's location?
Would you like the same location on May 5, 2012?	Yes No
Please identify any other needs or concerns.
How should your group be identified in print?
Briefly describe your entertainment (i.e. gymnastics group, heavy metal band, country music, rock and roll, etc.):
Please provide your booking information:
Do you know others who might want to perform? If so, please provide his/her name and contact information: