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2. Name
3. Organization name
5. Street address
7. City
8. Zip Code
10. Phone number
11. Email address
13. Website
15. Program Title
17. Program Description
19. Estimate program length
20. Maximum audience size
22. Your availability to present
    Examples: evenings, weekends, specific dates, or months
24. Library equipment or staff needed
26. Space needed
    Example: 12'x12' performance space
28. Available to Present at

    1. Centennial Library
    2. Crooked Lake Library
    3. Johnsville Library
    4. Mississippi Library
    5. North Central Library
    6. Northtown Library
    7. Rum River Library
    8. St. Francis Library
30. Fees Required
32. How will you help promote this program?
34. Additional requirements or comments
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field