Chautauqua/Speaker Application Form

IMPORTANT—PLEASE NOTE: Have you confirmed these arrangements with your presenter? If not, you must do so before applying to KHC!

BOOKING FEE—Fill out one application per program — do not double up.



Limit: A total of two (2) reduced-cost programs, including no more than one (1) Chautauqua character, per sponsor per year. These presenters may be scheduled for dates through July 31, 2011. If you apply online an invoice will be sent to you along with the contract.

Return the form, with booking fee, to:
Kentucky Humanities Council, Inc.
206 East Maxwell Street
Lexington, KY 40508-2613

Type of organization:	For-profit organization Non-profit organization
Name of group:
Estimated audience (40 minimum for Chautauqua):
Full Name:
Address:
Address Line 2:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code:
Phone:
Email Address:
Speaker or Chautauqua Performer Requested:
Speaker's Topic:
Date & Time:
Location (Street Address or Building, and Town):
Comments: