Date: ________________

NAME: _______________________________________________________________

ADDRESS: ____________________________________________________________

CITY: ____________________________ STATE : ____________ ZIP: ___________

TELEPHONE: _________________________________________________________

EMAIL ADDRESS: ______________________________________________________

EVENT ATTENDED: ____________________________________________________

DATE ATTENTDED: ____________________________________________________

Is concern/request ADA (American Disabilities Act ) related ? Yes _____ No ______

CONCERN/REQUEST: ­­__________________________________________________

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Please return to:

Kentucky Exposition Center, Att: PR/Media, P.O. Box 37130 , Louisville , KY 40233