Contact Information

Name *:

Email Address *:

Daytime Phone:

Evening Phone:

Event Information

Event Info (including date):

KTBS Talent will (choose one):
Emcee
Judge
Parade Grand Marshall
Speak About Television
Other

Time from start to finish:

Do they need to bring a tape?:

If so, what type?:

Will a tape player and TV be provided? :

KTBS Speaker Requested

First Choice:

Second Choice:

Third Choice:

Directions from KTBS 3 to Event:

Expected Attendance at the Event:

Age Group of Attendees: