Performer Certificate

Please use proper name capitalization.
Please type only one email.

Certificate Holder

Venue where you are performing

Please Enter State Abbreviation Ex: Florida = FL
Attach a File (Insurance Guidelines, Sample Certificates, Venue Information)
Files must be less than 6 MB.
Allowed file types: txt doc docx xls xlsx pdf jpg jpeg gif png.
Format: xxx-xxx-xxxx
Date Needed - Click in box for popup calendar *
E.g., 2017-02-26

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