Application for Event Assistance from The

Application for Workshop / Event Assistance From the

Ellen Taylor Foundation for Junior Shaggers

Application Date: ______

Event Coordinator: Name: ______

E-Mail:______Phone

Address: ______

City/State/Zip______

Recommended By: ACSC Club: ______

Contact: ______

E-Mail:______

Phone: ______

Date of the Event: Date: ______Time: ______

Location of Event: Place: ______

Street Address: ______

City, State, Zip: ______

Description of Event (include flyer if available): ______

Is the event Smoke free? ______Is the event alcohol free? ______

Is the event free to all Juniors? ______How many Juniors do you anticipate? ______

Does event include a Beginner workshop and an Intermediate/Advanced workshop? ______

Will there be at least two hours of social dance time? ______

Do you plan to make this an annual event? _____ Do you plan to provide food? _____

Mail form to: Garrett Humphries

253 Congaree Park Drive

West Columbia, SC 29169

Or scan and e-mail completed form to:

Revised 4/25/15