Please complete this form and print this form. It may be faxed or mailed to:

Tara Boosey
Special Counsel
10 Cadillac Drive
Brentwood, TN 37027
Fax 615.373.1851
Tara.Boosey@SpecialCounsel.com

Applicable Fees:$200 + $20 Booking Fee and .38 cents per mile

Name Of Business Organization: 

Contact Name: 

Mailing Address: 

City/State/Zip      

Daytime Phone 

Evening Phone: 

Fax Number: 

E-Mail Address: 

Name Of Event: 

Date Of Event:                        Time Of Event: 

Check All That Apply:

  Not-For-Profit Organization                                    Community/Civic Group 

  Business                                                                  School

Check The Box That Best Describes Your Event:

  Speaking Engagement                                              Convention And/Or Trade Show                  Volunteer Recognition

  Community & Civic Event                                         School Assembly                                          Grand Opening

  Public Appearance                                                    Sporting Event                                           Special Event

  Fund Raiser                                                               Local Competition                                     Fashion Show

  Emcee                                Perform                                    Appear in crown                   Autograph Session

Event Setting:   Indoors                Outdoors

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