Event Registration Form

= required fields

Company or Organization (if applicable)

Prefix

First Name

Middle

Last Name

Suffix

Address

Suite/Floor/Apt

This address is a

City

State

Zip

County

Phone

E-Mail

Event name

Event date

Number of tickets/seats

Name of guest(s), enter 'none' if not applicable

How did you learn about this event?

Join Mailing List

Please indicate your interests by selecting from the following:

	IHC Newsletters & Announcements		Events & Educational Programs
	The Public Square at the IHC		Teacher Programs
	Café Society		Spanish-Speaking Programs
	Grants		Traveling Exhibitions
	Volunteering

By providing the requested information, you will be included on our mailing list. You will receive periodic emails and mailings according to your interests. We respect the privacy of our audiences and will at no time sell or distribute personal information to any party not directly affiliated with the Illinois Humanities Council and The Public Square at the IHC and its programs.

Please Note: We will release reserved seats 10 minutes before all programs begin if registered attendees have not yet arrived.

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