(Applications DUE October 19, 2001)
Contact Name:
Address:
City, State, Zip:
Phone Number(s) day_________________eve:___________________
Email Address:
Name (spelled as you would like it to appear in the program.):
Description of your poetry and/or information about yourself you'd like shared in your introduction:
KGP is able to provide sound and lighting. We have limited access to microphones. Anything beyond our capabilities will need to be discussed with the KGP (608-226-9997).
Number of mics needed:
Additional technical equipment needs:
May we have permission to use your name in media coverage, advertising, general publicity or on the Kissing Girls website? Yes No
May we have permission to use a photograph of you in media coverage, advertising, general publicity or on the Kissing Girls website? Yes No
May we have permission to video tape your act for archival purposes only (not for sale or reproduction)? Yes No
Demographic Information (Optional)
Do You/All Group Members define yourself as Lesbian?
YES__________ NO__________
Age(s):
Race(s)/Ethnicity:
Differently Abled: YES__________ NO__________ Please describe (include information about any assistance you might need in order to help make your participation easier).
Are you a past Lesbian Variety Show participant?
YES__________ NO__________
If yes, the names of groups/participant and dates of participation:
Thank you for applying to Kissing Girls Productions Poetry Reading.
Please send this application to KGP, PO Box 6091, Madison, WI 53716.
IMPORTANT DATES !!!
This application is DUE BY October 19th
Performance/Reading is on November 18th