Please note the following:
First Name
Last Name
Email Address*
Mobile Phone*
Business Phone
Event Date
Event Name
Event Type
Event Time
Gus Appearance Time
Address
City
StatePlease Select...AlaskaAlabamaArkansasAmerican SamoaArizonaCaliforniaColoradoConnecticutD.C.DelawareFloridaMicronesiaGeorgiaGuamHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMarshall IslandsMichiganMinnesotaMissouriMarianasMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaPuerto RicoPalauRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVirgin IslandsVermontWashingtonWisconsinWest VirginiaWyomingMilitary AmericasMilitary Europe/ME/CanadaMilitary PacificAlbertaManitobaBritish ColumbiaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Territory
Zip Code
Estimated Number of People in Attendance
Brief description of the event and elements you’d like Gus to be involved in