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2. Name*
4. Address*
6. City*
7. State*
8. Zip Code*
10. Phone Number*
12. Email Address*
16. Are you the presenter?*

    1. Yes
    2. No
18. If not, please enter the name and contact information of the presenter.*
20. Does the presenter represent a business or non-profit?*

    1. Yes
    2. No
22. If yes, which non-profit. Please include contact information for the nonprofit.*
26. Program Title*
28. Detailed program description*
30. Presenter's Qualifications*
32. What is the target age group?*

    Check all that apply.

    1. Everyone (All Ages)
    2. Family
    3. Babies (Pre Walker)
    4. Ones (12 - 24 months)
    5. Toddlers (2 - 3 years old)
    6. Pre-Ks (4-5 years old)
    7. K - 5th Grade

    1. 6th - 8th Grade
    2. 9th - 12th Grade
    3. New Adult (18-25)
    4. Adults
    5. Seniors (50+)
    6. Other
34. If other, please explain target age group.*
36. Program duration*
37. How much setup/tear down time will the presenter need?*
39. Is this a one-time program or a series of programs?*

    1. One-time Program
    2. Series of Programs
41. Preferred date, time, and day of the week of program.*

    All programs must be during open hours. The library is open Monday - Thursday: 10 am - 9 pm, Friday: 10 am - 6 pm, Saturday: 10 am - 5 pm, Sunday: 1 - 5 pm

43. Where has the presenter done the program before?*
45. Will the presenter require registration to attend?*

    1. Yes
    2. No
47. Is there an attendance or registration limit of attendance?*

    1. Yes
    2. No
49. If yes, please enter maximum attendance.*
51. Equipment/Supplies Needed (including technology)*
53. Does the presenter have any space requirements or a specific room in mind?*
55. Is the presenter requesting a speaker/performance fee?*

    1. Yes
    2. No
57. If yes, what is the fee*
59. What are the intended learning outcomes for attendees? What knowledge/skills will they gain as a result of attending?*
61. It is the Library's mission to help our citizens develop their talents, acquire knowledge, embrace their passions, and fulfill their dreams. How would your program align with this mission?*
63. References
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65. 1. Receive an email copy of this form.
66. Email address

    This field is not part of the form submission.

67. Submit

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