2012 GOSPEL MUSIC EXPO ARTIST ENTRY FORM
Artist/Ministry Name:
Mailing Address:
City:
St:
Zip:
Contact Person:
Main Contact Phone:
Other Contact Phone #:
Phone numbers must include area code. Please also include dashes where appropriate.
Email Address:
Website Address:
Performance Times
1st Preferred Performance Time:
(Please check only one time frame per preferred time)
2nd Preferred Performance Time:
3rd Preferred Performance Time:
List Special Requests (if any):
Spots Requested:
(Multiple Spots may be bought, but cannot run concurrently
Number of 15 Minute Slots (Choose from List:)
Number of 20 Minute Slots (Choose from List:)
@ $60/ea =
@ $80/ea =
$
$
Total =
$
Please calculate the dollar amounts and totals and place in appropriate boxes
Payment:
Our Payment will be in the form of:
Credit & Debit Cards will not be charged until after Jan 15, 2012. Checks must be received by Jan 15, 2012.
Type of Card:
Card Number:
Exp Date:
Cardholder Name
Billing Address:
City:
St:
Zip:
If you have made errors and wish to correct, please press Reset Button:
If you have completed all information, please press the Submit Button:
Please mail checks to:
Robbie Maxwell
10891 AL Hwy 79
Scottsboro, AL 35768
If you have questions, please call Robbie Maxwell at (256)574-0138 or Buddy Tennison at (769)218-3751.
