Program Information Form

2. Program Title

4. Preferred Date

5. Time

7. Second Choice Date

8. Time

10. Contact Person

12. Address1

14. Address2

16. City

17. State

18. Zip

20. Phone

21. Email Address

23. Program Description

25. Instructor's Qualifications (Degrees, Certificates, etc.)

27. Equipment Needs

    1. Computer
    2. Projector

    1. DVD/CD Player
    2. Podium/Lectern

    1. Microphone
    2. Other

29. Room Arrangement

    1. Theater (chairs in row only)
    2. Classroom (chairs with tables)

    1. Empty (No tables or chairs)
    2. Other

31. Other Notes

33. PLEASE NOTE: The library’s program committee will evaluate your program based on its educational, informational, and recreational merit. Programs can NOT be promotional in nature or held with the intention of generating revenue. We will notify you in a timely manner if we decide to host your program.

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

    This field is not part of the form submission.

37. Submit Submit and Print

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