Professional Documents
Culture Documents
________________________________________________________
Contact Person:
________________________________________________________
Mailing Address:
________________________________________________________
________________________________________________________
Work Telephone:
____________________________
____________________________
Fax:
____________________________
Ththe wor k
Email:
___________________________________________________
All disclosed information will be kept confidential (excluding information provided for promotional
purposes). The partnership fee is non-refundable and applications submitted without the fee will
not be processed. We respectfully request that all forms be submitted by March 30th in order to
allow ample time to book a requested movie and/or musician.
Date
June 24
July 1
July 8
July 15
July 22
July 29
Aug. 5
Aug. 12
Aug. 19
*Preferred Movie
or Theme
NO MOVIE
Fee
$320
Company
Partnership Details
$320
$320
$320
$320
$320
$320
$320
Aug. 26
$320
Sept. 2
$320
SUBTOTAL:
4
Company
Selection
()
Date
July 6
July 13
July 20
July 27
Aug. 3
Aug. 10
Aug. 17
Aug. 24
Aug. 31
Wednesday
Music in the Park
*Preferred Artist
Fee
$525
$525
$525
$525
$525
$525
$525
$525
KV Jazzfest Performance $525
SUBTOTAL:
$
Company
Partnership Details
Event supplies, equipment, materials and staffing will be provided by the Town of Quispamsis.
* If your preferred artist or movie is unavailable we will provide you with other popular choices.
Endorsement:
I / We will be bound by such terms in the event of a successful application. Completion
and submission of this form constitutes a contract. (Please retain a copy for your
records.)
Signature
___________________________________
Print Name
___________________________________ Date ____________________, 20 ______
Payment Method:
( ) Cash (Payable at Town Hall, 12 Landing Court)
( ) Debit
( ) Money Order
( ) VISA
( ) MasterCard
( ) Cheque (Made payable to the Town of Quispamsis)
Card Number and Expiry Date
_______________________________________________________
Print Name as it appears on card
_______________________________________________________
Cardholders Signature
_____________________________
Please submit completed form with payment to:
Megan Lucas, Program Director Fax: 506.848.5910
Town of Quispamsis, 20 Randy Jones Way, PO Box 21085, Quispamsis, NB, E2E 4Z4
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