CONTRACT INFORMATION SHEET

Payee cannot be a principal member o f the spo nsoring student organizatio

A.
Ev en t N a m e

EVENT INFORMATION

B. SPONSOR CO NTACT INFORMATION

Org an i z a t i o n /Dep a r t m en t Name

Ev en t D a t e

Prin c ip a l M e m b e r /Co n t a c t N a m e

Ev en t S t a r t T i m e

Ev en t E nd T i m e

Co n t a c t Ph o n e
(____ ____ ____) _____ _____ ____ -- ____ ____ ____ ____

Co n t a c t E m a i l

Ev en t L o c a t io n

Org an i z a t i o n /D ep ar t m e n t M a i l Co d e

Co n tr a c t D e l iv e ry M e t hod ( ch e c k on e)

F ax Mai l

Sp o nso r to p i c k up fro m Un iv e rsi ty Ev en ts Off i c e

C. ARTIST INFORMATION
Na m e o f Ar t ist / Sp e ak e r / Group Serv i c es t o b e p ro v id ed b y a r t is t

Perfo r m a n c e S t a r t T i m e

Perfor m a n c e E nd T i m e

UCSD to Pro v id e ( ch e ck a l l th a t a p p ly ) : O th e r , sp e c i fy :

So u n d

L i g h ts

Stage

No n e .

Art ist to Pro v id e ( c h e c k a l l t h a t app ly) : No n e O th e r , sp e c i fy : No t es/Sp e c i a l Condi t i ons

Sound

L igh ts

S t ag e

Ca t e g o ry (Ch e ck o n e ) : Co m ed i a n .

B and

Sp e a k e r O th e r :

DJ

O th e r Mu si c

D an c e Co m p an y

D. PAYMENT INFOR MATION

Amo u n t to b e P a id Pay e e N a m e ( ch e c k o n e) In d iv id u a l : _ _ _ _ __ _ __ __ _ __ __ __ _ __ __ __ _ __ __ _ __ __ __ _ __ __ _ __ __ __ _ __ __ _ _ Bu sin ess: _ _ _ _ _ __ _ __ __ _ __ __ __ _ __ __ __ _ __ __ _ __ __ __ _ __ __ _ __ __ __ _ __ __ _
Relati o n s h i p o f t h e a r ti st/ s p e a k e r / g r o u p n a m e d i n Se c ti o n C t o b u s i n e s s b e i n g p a i d ?

Self

Own er

E m p lo y e e _ ___

Ag en t

O th e r (p l e as e sp e c i fy )

Email ad d ress to wher e contract can be sent:

Ad d ress wh er e c h e ck is t o b e m a i l e d _ _ _________________________________________________________ __ _ __ __ _ __ __ _ __ __ _ __ __ _ __ __ __ _ __ __ _ __ __ __ _ __ __ __ _ __ __ Str e e t Addr ess _ _ _________________________________________________________ __ _ __ __ _ __ __ _ __ __ _ __ __ _ __ __ __ _ __ __ _ __ __ __ _ __ __ __ _ __ __ Ci ty State Zip Ho m e / Bu sin ess Address ( If d i ff e r e n t f ro m Ch e ck M a i l i ng addr ess) _ _ _________________________________________________________ __ _ __ __ _ __ __ _ __ __ _ __ __ _ __ __ __ _ __ __ _ __ __ __ _ __ __ __ _ __ __ Str e e t Addr ess _ _ _________________________________________________________ __ _ __ ___ __ __ _ __ __ _ __ __ _ __ __ __ _ __ __ _ __ __ __ _ __ __ __ _ __ __ Ci ty State Zip Pay e e T e l ep h o n e nu mb e r
(____ ____ ____ ) _____ _____ ____ -- ____ ____ ____ ____

P ay e e F ax Nu mb e r
(____ ____ ____) _____ _____ ____ -- ____ ____ ____ ____

Is p ay e e a n U .S . c i t i z en ? Y es No I f no , s t a t e v isa typ e and nu mb e r________________ __ _ __ _

Pri m a ry b u sin ess fo cu s o f th e co m p an y ?

Is p ay e e a f o rm e r UCSD e m p lo y e e ? No Y es ( If y es , p ro v id e d a t e o f s ep a r a t i o n ) _ _ _ _ _ __ _ __ __ _ __ __ __

rev CSI 8/11

0 4 . 0 4 . 0 6 P Y H S LB S