Entry Form
Entry Deadline: Monday, Aug. 8, 2016
Contact Carolyn Stout at 541-575-1827
Name of group or individual performing:_________________________________________________________________
Name of person submitting application:_________________________________________________________________
Address:___________________________________City:_________________State:________Zip:__________________
County of Residence:_________________________(required) Phone Number__________________________________
)&-! !%&)$+!&% &) + %%&,%) &,+ /&,)*# &) )&,' $$)* + + + %%&,%) % ,* . %
!%+)&,!% /&, &) /&,) )&,' &, % .)!+ + !* !%&)$+!&% &% + " & + !* &)$
Number of people in act:_________
Name Name
(Last, First)
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List ALL group members below (use back if necessary)
Age
Age
Birth Date
Birthdate
Home/Cell Phone
Home/Cell
Phone
,#+
&,+
____ I certify that no person listed above belongs to a musicians’ union, nor does any person’s talent provide more than
50% of his/her income (if income exceeds &7,500). I/we understand I/we may be required to submit tax information.
____ I certify that no person listed above placed first at the State Fair Talent Contest in the prior 2 years
____ Vocal
____ Magic
____ Other
____ Dance ____ Instrumental ____Comedy
____ Band (no more than 3 instruments. No drum sets.)
Briefly describe your act, including instruments, props, choreography, etc. (Performance may not exceed 5 minutes)
_______________________________________________________________________________
_______________________________________________________________________________
$ & '! +& ')&)$
/' & &$'%!$%+ Thumb Drive _______CD _______Piano _______Other
(,!'$%+ % Mics_______Electronic Piano (must supply your own) CD Player_______
I/we wish to enter the Grant County Talent Contest and agree to abide by the rules. I
certify that all information provided above is true and accurate.
!%+,)+
2016 ★ GRANT COUNTY FAIR ★ PAGE 31
