Uniquely You - New Years Bash 2025 Variety Show Registration Form (Date Pending for Feb 1st 2-5pm)
Regardless of your disabilities we want you to take the stage and share your talent!
Name of Participant or main contact
First Name
Last Name
Parent's Name if applicable
First Name
Last Name
Company Name if applicable
Date of birth
-
Month
-
Day
Year
Date
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Description of your act
How long is your act, talent, magic show, song, performance?
Please note that any equipment needed for your act will need to be provided and set up by you. Will you need time to set up equipment?
Yes
No
Please provide a video of your routine if available. Not manditory for participation
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