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Thank you for your interest in the Diversity Celebration. If you have any questions, please contact Gus Pena, Assistant Director of Multicultural Education at Appalachian State University, at 828-262-6252, or penaae@appstate.edu.

* Contact Information: Name:

Cell Phone number:

* Land Line Phone Number:

* Email address:

* Campus or other Mailing Address:

* Organization/Group (if any): *Please note, this will be the name used on all publicity items.

* My group will do the following: Please check all boxes that apply, then complete the appropriate section(s) below. **Please note that if you are providing a workshop or hands-on activity, you are responsible for providing all materials needed for the participants.** Performance (i.e. dancing, singing, storytelling) Presentation (i.e. Volunteerism, How to Sing in German) Display/Exhibit Table Workshop (i.e. Oragami, Jewelry Making, Dance) Hands on actvity for All Ages

* For display or exhibit tables: Will you need an electrical outlet at your exhibit table? Not Applicable Yes No

If you are selling any items please list the item(s) and price:*

If you plan to collect donations, please explain:*

If you are selling food, please list your menu and prices:**

*Please note, if you are selling items or collecting donations, you will need to complete a solicitation form in CSIL (Suite 219, Student Union). Make sure to leave the Student Union copy with the CSIL staff so we may file it with your application. **All non university funded student clubs and organizations can apply for an educational program funding allocation through Club Council to help off-set the cost of food items. To request this funding visit CSIL to request an allocation form.

* For performances, presentations, activities, and workshops only Are you doing a performance? (ie. dancing, singing, story telling) Not Applicable Yes No

* Are you providing a presentation? (i.e. Volunteerism, How to Sing in German) Not Applicable Yes No

* Are you conducting a workshop? (i.e. Origami, Jewelry Making, Dance)++ ++Note, you are responsible for providing any materials needed for participants. Not Applicable Yes No

* Are you leading an interactive activity? (i.e. Culture Walk, Culture Sculpture) Not Applicable Yes No

If yes, please provide a description of the Performance/Activity/Presentation and/or Workshop:

* How long will your Presentation/Activity/Workshop/Performance last? Please note that the option for the entire event is for those conducting workshops or facilitating activities at the Unity Festival only. Not Applicable 30 Minutes 45 Minutes 60 Minutes The entire event

* If you are doing a performance or a presentation, activity or workshop on Tuesday, March 23, 2010, please check all of the times that you could perform/present: Not Applicable 3:00 P.M. 3:30 P.M. 4:00 P.M. 4:30 P.M. 5:00 P.M. 5:30 P.M. 6:00 P.M. 6:30 P.M. 7:00 P.M. 7:30 P.M. 8:00 P.M. 8:30 P.M. 3:00 - 9:00 P.M. (the entire event)

* Are you willing to present, perform or conduct the activity/workshop more than once? Not Applicable Yes No

If you are doing a performance or an activity, please list all audio/visual and or stage needs:*** ***Please note that there are limitations to the equipment that can be provided. You will be notified prior to the time of the event to let you know what equipment will be provided for your use. Data Projector Wireless Mic CD Player VCR Slide Projector Laptop Computer (IBM compatible with CD drive, but no floppy drive)

Number of chairs (if needed):

Number of stools (if needed):

Number of tables (if needed):

Number of microphones (if needed):

If you have any additional needs that have not been addressed, please list:

Please copy the word in the above image.