Special Appearance Request

This special appearance request form is for Peruna, the mascot, Liberty and Justice.

Are you requesting for Peruna, the mascot and/or Liberty and Justice? (select one)

PERUNA, THE MASCOT
LIBERTY and JUSTICE
PERUNA, LIBERTY and JUSTICE

First Name:
Last Name:
Event Name:
Event Date:
Event Address:
City:
State:
Zip:
Event Begin Time:
Event End Time
Phone:	(ex. 555-555-5555)
Alternate Phone:	(ex. 555-555-5555)
Email:
*The request confirmation will be sent to the email address provided.

Event Description/Details: (max characters 255)

You have 255 characters remaining for your description.

You will be contacted in 2-3 business days.

Recreational Sports is a department in the Division of Student Affairs.