Request to perform in cultural program
Name of the requestor:
Email:
Telephone:
Are you a life member?
Yes
No
Name of participants:
Age range of participants:
(e.g. 18-22 yrs)
Program item:
Please select
Dance
Song
Skit
Other
(Provide details below)
Duration:
(e.g. 5 minutes)
Details/special instructions:
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