Please note that required fields are listed in bold.

Company Name (if applicable): 

Name: 

Address: 

City: 

 State:   Zip: 

Phone:

Email:

Is the Billing Contact the same as above?

Yes     No 

If the Billing Contact is different than above, please complete this section.

Company Name (if applicable): 

Name: 

Address: 

City: 

 State:   Zip: 

Phone:

Email:

How did you hear about the History Museum? (Check all that apply)

 Friend     TV     Radio     Advertisement (print)     Other 

What dates are you interested in? Please list primary date and alternative dates.

1.     Primary
2.     Alternative
3.     Alternative

In what space(s) are you interested? (Check all that apply)

What is the size of your group?

 1-50     51-100      101-200      200+ 

What kind of event are you planning? Please offer short description including event title: