Hurricane Gap Community Performance Institute
Event Date: July 23-25 2021

Event Address: Pine Mountain Settlement School 36 Hwy 510 Bledsoe KY

Contact Kate Handzlik at (606) 589-3136 or khandzlik0001@kctcs.edu

Sign in to Google to save your progress. Learn more
Name *
Organization / Affiliation
(if applicable)
Email *
Phone Number *
Mailing Address [P.O. or Street Address] *
Mailing Address [City] *
Mailing Address [State] *
Mailing Address [Zip Code] *
Additional Information about you... *
Provide a little bit of information about yourself and/or why you’d like to join us at Hurricane Gap. If you'd like to specify pronouns or let us know anything else that would support your full participation, please include that here.
Which parts of Hurricane Gap will you attend? *
Required
We are featuring the full-length production of Clear Creek Creative's Ezell during this year's Hurricane Gap.  Your ticket for the performance and meal for Ezell is included with Hurricane Gap registration.  Please choose which day you will attend. *
Your Ezell ticket is included with your Hurricane Gap registration -- use the code "HurricaneGap" to reserve your free ticket on the website.  More details about the experience at the Eventbrite link:  https://www.eventbrite.com/e/ezell-at-pine-mountain-settlement-school-tickets-161231609083?aff=ebdsoporgprofile
Required
Lodging *
I will need a room at Pine Mountain Settlement School for:
Required
If you have a preference for a specific roommate, a single room or extended stay, please indicate below.  
Most people will be in recently renovated dorm-style lodging.  There are a limited number of single rooms available.
Dietary Requests and Allergies *
Please let us know if you have dietary requests or allergies so we can do our best to accommodate. Mark all that apply and use the “Other” to indicate additional requests.
Required
Accessibility *
 If you require accommodations for a disability, please use the space provided below to describe how we can best accommodate your needs.
Please briefly explain your comfort level in attending an in-person gathering in light of COVID-19. *
Hurricane Gap staff will adhere to all state and local regulations but understand that all participants may not be ready to resume "normal" activities. Would you prefer indoor or outdoor spaces for workshops? Will you be wearing a mask? Are you vaccinated?  Do you have any other requests or suggestions related to pandemic protocol for this event?
Sliding Scale Registration Fee Options: *
Registration fee is $175 for the whole conference. Many scholarships are available. Do not hesitate to ask for a scholarship.
Required
SLIDING SCALE or SCHOLARSHIP: Please indicate the amount you would like to contribute or how much you are requesting
Payment Options *
Is there anything else you'd like us to know?
Thanks for registering! We look forward to being together at the Institute.
If you have any additional questions or concerns, please contact Kate Handzlik at khandzlik0001@kctcs.edu or 606-589-3136
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms