Request for Programs

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Enter Email Confirm Email

Phone(Required)

Program Information

Program Title(Required)

Program Type(Required)

Hands-On Workshop

Demonstration

Lecture/Talk

Other

Other(Required)

Intended Audience(Required)

Adults

Families

Children

All Ages

Ages for Children as the intended audience(Required)

Proposed Duration(Required)

Proposed capacity (Maximum/Minimum)(Required)

Preferred dates or timeframe(Required)

Scheduling Restrictions(Required)

Materials & Requirements

Equipment or Materials Needed(Required)

Special Setup Requirements

Will you supply materials, or does Historic Bethlehem Museums & Sites need to provide them?(Required)

Presenter Supplies all materials

Historic Bethlehem Museums & Sites supplies all materials

Material Cost(Required)

Presenter Background

Have you presented programs at a museum or cultural institution before?(Required)

Yes

No

Please list where you have presented.(Required)

Compensation

Are you requesting an honorarium or teaching fee?(Required)

Yes

No

Requested Amount(Required)