Form Center

* indicates a required field

2. Name*
3. Organization /Business Affiliation if applicable:
5. City
6. State
7. Zip Code
9. Email Address*
10. Phone Number
11. Website
15. Program Type*

    Select as many options as apply

    1. Author/Expert Speaker
    2. Performance
    3. Workshop/Class
    4. Other
16. Target Audience*

    Select as many options as apply

    1. Children's program
    2. Teen program
    3. Adult/Senior program
    4. Family Program
17. Library Location*

    Which library are you interested in?

    1. Trumbull Library
    2. Fairchild-Nichols Memorial Branch
    3. both/either
19. Title of Program*
21. Program Description:*

    Please provide a thorough description of your program

23. Do you charge a fee?*

    1. Yes
    2. No
24. What is your fee?*

    Note: Payment takes 6-8 weeks to process.

    
    

26. What is the intended purpose of this program?

    When answering this, please think about the program's impact and how it might fill a community need.

28. What is your desired outcome for attendees of this program?

    (ie, learning a new skill, acquiring new knowledge/way of thinking, being entertained, etc.)

30. What type of space, set up and equipment are required?
32. What is your preferred time or day of the week?

    Please indicate if you would like to present on specific dates keeping in mind the library schedules at least 90 days in advance. 

Leave This Blank:


33. Submit