ARTIST/SPEAKER PARTICIPATION

SPEAKERS

POETS

* Indicates required field

I/We would like to be a participant at your upcoming events/activities! *

Yes No Maybe

# of people you are referring to (example: If you are only person just put 1) *

Email Address *

Name *

First

Last

Phone Number *

Stage name of or name of group *

Tell us about yourself or your group! (Please include any youtube videos or facebook page information you may have) *

Best time to reach you *

Morning Afternoon Evening I have a busy schedule, best to contact me after 9:00 p.m.

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