PLEASE PROVIDE THE FOLLOWING INFORMATION

1. (*required)
2. First Name
3. Last Name
4. Daytime Phone
5. Evening Phone
6. Email Address

1. Event Date
2. EVENT LOCATION
3. Name of Venue Name of Venue 63rd Street Beach House
 A New Leaf 
Architectural Artifacts 
Arlington Lakes Golf Club The Art Center of Highland Park Berger Park Cultural Center 
Black Walnut Gallery Broadway Armory Park 
Buckingham Fountain Burnham Park
 The Byron Colby Barn at Prairie Crossing Cancer Survivor’s Garden Catalyst Ranch Chicago Cultural Center Chicago Curling Club Chicago Women’s Park and Gardens Columbus Park Refectory Daley Bicentennial Plaza Dawes House Douglas Dawson Gallery Douglas Park Cultural and Community Center Estonian House of Chicago Friendship Park Conservatory Gallery 312 Garfield Park Conservatory The Glacier Ice Arena The Golden Triangle Gallery Gorton Community Center at Gilson Park Greenbelt Cultural Center Harris Theater for Music and Dance at Millennium Park Heller Nature Center Highland Park Community House Humboldt Park Field House and Boat House Ida Noyes Hall (University of Chicago) Irish American Heritage Center Jackson Park Yacht Club Katherine Legge Memorial Lodge Kenilworth Club Lake Forest Club Levy Senior Center Lincoln Park Conservatory Loft on Lake Lumen Mars Gallery Maxim’s: The Nancy Goldberg International Center Newberry Library Northerly Island North Rose Garden North Shore Yacht Club Park West Peggy Notebaert Nature Museum Prairie Production Primitive Gallery Promontory Point Redfield Estate at The Grove Rob Roy Country Club Village Salvage One Sheridan Shores Yacht Club South Shore Cultural Center The Tiffany & Co. Foundation Celebration Garden Washington Park Refectory Westgrand Studios Wilmette Harbor at Gilson Park Wilmette Woman’s Club Windy City Fieldhouse Winnetka Community House Winnetka Woman’s Club Woman’s Club of Evanston ZHOU B Art Center Other
4. OtherOther
6. PERMIT ALREADY SECURED?
7. yes no
8. APROXIMATE NUMBER OF GUESTS
9. Adults
10. Children

1. ENTERTAINMENT
2. Band DJ
   Photograper Videographer
3. Entertainment/Attractions
4. (select all that apply)
5. Entertainment/Attractions Disc Jockey Airbrush/Face Painting Aladdin's Magic Carpet Ride Balloon Artists Ba-Skee-Ball Berry-Go-Round Big Trucks Bingo Boom Blaster Bouncy Ball Relay Race Bouncy Boxing Bumper Cars Bungee Ball Bungee Run Bungee Bull 3-Lane Bungee Run Carnival Miday Castle Moonwalk Castle Wizard Circus train Clowns Corn Toss Dalmation Dog 4-In-1 Combo Dino Circle Dixieland Ferris Wheel Dragon Train Dunk Tank El Paso Track Train Extreme Obstacle Course Frankie Funny Bunny Ride Giant Inflatable Slide Giant Slide Giant Swing Giant Surf Giant Inflatable Twister Goal Kick Gravitron Haunted Forest Horseshoes Human Spheres Inflatable Pinball/Ring Toss Inflatable T-Ball Classic Jacob's Ladder Jurassic Adventure Kiddie Land Kiddiepillar Kite Flyer Laser Tag Laugh-N-Learn Micro Reality Stock Car Racing Midway Basketball Miniature Golf 9 Hole Mini Golf 3 Hole Mississippi Train Ride Money Cube Monster Truck Moonwalk Murlin's Magic Obstacle Course Peanuts the Elephant Pedastal Joust Pitch & Burst Pony Rides Pop-A-Shot Quarterback Toss Radar Baseball Speed Pitch Radar Soccer Kick Rock Climbing Wall Royal Flush Dunk Tank Royal Trackless Train Seaweed the Sea Monster Slot Car Racing Spin Art Spin the Apple Ride Starship 2000 Super Splash & Glide Surf Rider Targeted Paint Ride Teen Arcade Area Tilt-A-Whirl Tornado Twin Spin Velcro Fly Water Balloon Battle Wind Jammer Zero Gravity

1. MENU SELECTIONS
2. (select all that apply)
3. Main Menu
4. Main Menu Great Ol' Barbcue A Day at the Fair The Texas Two-Step Barbecue Anyone? Battle of the Sausages Coney Island Day Steak Your Claim Northwoods Special A Mini Taste of Chicago I Want My Own Menu
5. Salads/Sides
6. Salads/Sides Blue Sky Cole Slaw Caribbean Cole Slaw Marinated Three Bean Salad Hel’s Tortellini Salad California Pasta Salad Chilled Cous Cous Salad Red Beans & Rice Old-Fashioned Potato Salad Taffy Apple Salad Hawaiian Salad Hel’s Famous Caesar Salad Roast Corn on the Husk Marinated Vegetable Salad Macaroni & Cheese Salad Blue Sky Baked Beans Roasted New Potato Salad Chili Con Carne Au Gratin Potatoes Hot & Creamy Macaroni & Cheese Sweet Corn on the Cob Fresh Fruit Salad Chilled Freshly Sliced Watermelon California Garden Salad Fresh Fruit Basket
7. Dessert
8. Dessert Ice Cream Cart Assorted Homeade Cookies Assorted Dessert Bars
9. Snacks
10. Snacks Fresh Popped Popcorn Sno Cones Cotton Candy Nacho Chips with Cheese Roast Corn Hot Pretzels Churros
12. Drinks
13. Soft Drinks Alcoholic Beverages

1. How did you hear about us? How did you hear about us? Previous Customer Guest at a Party Heard From a Friend Yellow Pages Web Surfing Saw Our Truck Venue Referral Other
2. Tell us briefly about your visionTell us briefly about your vision...

 

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