2016 martin luther king jr. Celebration deadline: December 4, 2015



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2016 MARTIN LUTHER KING JR. CELEBRATION DEADLINE: December 4, 2015

EVENT / ACTIVITY RESERVATION FORM (Please print or write legibly)


By completing and returning this form by the deadline, your event / activity will be published in the MLK booklet and in the South Bend Tribune. Please return to: Dea Andrews, South Bend Heritage Foundation, 803 Lincoln Way West, South Bend, IN 46616. Phone: 574-289-1066 ext. 215. Fax: 574-289-4550. E-mail: deaandrews@sbheritage.org
1. CONTACT INFORMATION ON EVENT / ACTIVITY SPONSORS
Sponsoring organization / group / individual ________________________________________

__________________________________________________________________________________________________

Contact person (s) coordinating the event / activity: _________________________________________

__________________________________________________________________________________________________

Phone: _______________________(day) ______________________ (evening) _____________________(cell)

Fax: _______________________ E-mail: _____________________________________________________________

Mailing address: _______________________________________________________________________________

__________________________________________________________________________________________________

2. ACTIVITY / EVENT INFORMATION
Name of event / activity: ______________________________________________________________________

__________________________________________________________________________________________________

Date (s) of event / activity: ____________________________________________________________________

Location (s) of event / activity ________________________________________________________________

__________________________________________________________________________________________________

Cost of event, if any:___________________________________________________________________________

Event / Activity Description: Be specific about the activity and include its format (eg. presentation and discussion; workshop; guided activities, etc). You can attach any written information about the event / activity.
__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. ADDITIONAL EVENT / ACTIVITY INFORMATION
Targeted Population of event / activity: (check one)
_______Youth _______Teens _______Adults _______General

# of participants: (check one & fill in the blanks)

_______ restricted to (_______ ) individuals

_______ unrestricted with an ideal size of (_______ ) individuals

_______ open to all who want to attend
For events / activities that require reservations or appointments: Contact information if different than above.
Name:___________________________________________________________________________________________

Phone: _______________________(day) ______________________ (evening) _____________________(cell)

Fax: _____________________ ___E-mail: ____________________________________________________________

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4. SET UP INFORMATION NEEDED FOR CENTURY CENTER

For events held on MLK Day, January 18, 2016, at the Century Center


Space requirements: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Equipment requests: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Other needs:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


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