Program For: *

 Child Tween YA Adult

Target Audience (ages, i.e. 5-12 or adult): *

Submitted By: *

Did you get Dept. Head/Supervisor's Approval Before Filling Out This Form?*

 Yes

Enter your supervisor's email address:*

Enter Your Email Account If You Wish To Receive A Copy Of This Form's Results:

(If you wish to send to multiple accounts, separate addresses with a comma)

Program Title: *

Program Description: *

Locations - Dates - Start Times - Length of program: *

(if necessary, include room name)

Attendance Goal: *

Preregistration Required: *

 Yes No

Preregistration Info:

(number of spaces available/preregistration date/how to preregister (online/phone/person)

Online Preregistration: *

 Yes No

Programming Supplies:

(Optional - Craft, refreshments, display, etc.)

Did you reserve meeting room space + set up, if necessary. (Optional):

 Yes No

Contact Information of Performer or Programmer - Name/Phone:

Extra Notes / Setup Requirements:

(please include performer fees)

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Promotions Needed?

Do you need promotions for this program?*

 Yes Promo No Promo

If "Yes" Fill out the following

Date Needed By: (Required if Promotions Needed)

Kind Of Work:
 Sign/Media Zone Handout (1/2 or 1/4 sheet) Social Media Post Bookletters Email PDF Web/Calendar Post Bookmark Other (fill out below)

Other Kind:

Double Sided:
 Yes No

Size:
 Letter Legal Tabloid 1/2 Sheet 1/4 Sheet 4-Tile Poster

Other Size:

Quantity:

Paper Color: (Please note that not all colors are available.)

Cardstock:
 Yes No

Backing:
 Yes No

Laminated:
 Yes No

Information Layout - Please email any photos or graphics to booktalkreq@lafayettepubliclibrary.org

Special Instructions:

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