First/Last Name:       

Email address:          

Telephone Number:

What is your special talent?
Singing
Dancing
Playing instrument
Other

Individual Performance Type ( 1 ) in box. x $1.50 per ticket

If you have more than one person, how many people in your group? x $1.50 per ticket

Your total cost will be on your receipt after submitting this form.
Please pay all fees at the door of this event.