Mavs Man Appearance Request Form

ORGANIZATION_______________________________________________________________

TYPE(PLEASE CHECK)___BUSINESS___CHARITY___CHURCH___CIVIC ___SCHOOL ___OTHER

ADDRESS_____________________________________

CITY___________________STATE_____ZIP________

TELEPHONE( ___) ________________________________

CONTACT NAME________________________________ CONTACT TELEPHONE(__) ________________

E-MAIL__________________________________

ON-SITE CONTACT NAME & TELEPHONE______________________________________________

EVENT DATE _____________________ EVENT TIME - FROM:________ UNTIL:_______

EVENT LOCATION _______________________________________________________________

ADDRESS_____________________________________

CITY___________________STATE_____ZIP________

EVENT THEME_______________________________________________________________

EVENT DESCRIPTION (please specify: Who benefits?, Other Celebrities or Dignitaries?)
_______________________________________________________________________________________

MASCOT'S ROLE AT EVENT_______________________________________________________________

AUDIENCE SIZE________ AUDIENCE AGE RANGE_________________________________

PAYMENT OPTIONS:

CHECK ENCLOSEDVISA M/C AMEX DISCOVER CARD

CREDIT CARD#_______________________________________

EXP. DATE_________________

CVV or CID (see picture on right)_________________

BILLING ADDRESS ____________________________________

CITY___________________STATE_____ZIP________

NAME ON CARD______________________________________

SIGNATURE_________________________________________

PAYMENT IS DUE TWO (2) WEEKS PRIOR TO DATE OF EVENT!

Please return completed form to:
Dallas Mavericks
Attention: Jim Tennison
2909 Taylor St
Dallas, TX 75226
or fax to (214) 752-3860

MAVS STAFF USE ONLY
CONFIRMATION OF RECEIPT: DATE_____ TIME_______ VIA____________
CONFIRMED OR DECLINED: DATE_____ TIME_______ VIA____________
SCHEDULED: __________________________TIME_________