Autumn on the Square 2012 Talent Show Entry Form

Autumn on the Square- Sept 29, 2012
ENTRY FORM
Application Deadline: September 21, 2012
Rehearsal: September 27th at 6:00 City Square Gazebo
Marianna/Lee County Chamber of Commerce
870-295-2469
Name:____________________________________________________________________
Address:__________________________________________________________________
Phone Number:_______________________ Cell Phone:_____________________________
E-Mail Address:_____________________________________________________________
Eligibility:
_____Resident
_____Employed in Lee County
_____Attending school in Lee County
_____Adult or Child?
What type of performance?_____________________________________________________
Name of song to perform:______________________________________________________
Length of performance (limit 5-7 minutes):____________
$10.00 Entry Fee paid: Check #________ Cash________
Receipt # _____________ Date: ____________________
Performances (lyrics/dance interpretation) MUST BE family friendly.
The Autumn on the Square Committee reserves the right to discontinue performance
and disqualify contestant/contestants due to inappropriate lyrics/dance interpretations.
Signature:__________________________________
Date:______________________________________
Office use only Adult or Child Contestant # ______________
Performance time:________________
Thank you for your participation,
Tiffany Davis (AOTS Chairperson) Tammy Miller (Chamber of Commerce)