0929g Ticket Request Form for Visual and Performing Arts Parti

OMB Number: 2900-0759
Expiration Date: Xxx, 20XX
Respondent Burden: 35 minutes

TICKET REQUEST FORM FOR VISUAL AND
PERFORMING ARTS PARTICIPANTS
NATIONAL VETERANS CREATIVE ARTS FESTIVAL
ART EXHIBIT & STAGE SHOW
RESPONDENT BURDEN: The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with the
clearance requirements of Section 3507 of the Paperwork Reduction Act of 1995. We may not conduct or sponsor, and you are not required to respond
to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who must complete this
application will average 35 minutes. This includes the time it will take to read instructions, gather the necessary facts and fill out the forms.

Art Exhibit:
Stage Show Performance:
All visual artists will be issued a ticket for the stage show performance.
Performing artists will be on stage and do not require a ticket.
Please use this form to reserve tickets for your family members and friends.

VETERAN'S NAME (Last, First, MI)

Tickets are General Admission on a first come basis. Tickets are complimentary.
I will need

(#) ticket(s) for my family/friends

Tickets will be distributed to participants, staff, and volunteers
during the festival week unless otherwise arranged.

Submit completed Ticket Request Form by
Stephanie Torian
Host Site Coordinator (05/Vol)
VA Sierra Nevada Health Care System
975 Kirman Avenue
Reno, NV 89502
Phone: (775) 328-1411 / Fax: (775) 337-2276
Stephanie.Torian@va.gov

VA FORM
FEB 2014

0929g

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