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If you'd prefer to submit using a printed nomination form, here is a printable version [PDF]

Mott Community Relations:
Application for Entertainment Form




Please complete this electronic form

 

Before you submit the application, be sure you are familar with our Group Visits / Entertainment Guidelines.

Group / Performance Name:
Contact person name:
Telephone number
Address:
Email:
Fax:
Description of Presentation:
How many people (total) will be coming to the hospital:
What times/days of the week work best for your group?
Please describe how your visit will be of benefit to the patients and families and what specific items (if any) will you be bringing with you for the patients and families):

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