Please fill out the following form to inquire about booking an event and someone will get back to you as soon as possible. Feel free to contact Jessica Kwiatkowksi at jessica@Mixbarchicago.com. Please note that your event is not confirmed until you are contacted by MIX.

PERSONAL INFORMATION
First Name:
Last Name:
Company/Organization:
Birthday:	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986
Email:
Phone:
EVENT INFORMATION Please fill out all fields to ensure that we have all of the information we need to best assist you in the planning of your event.
Proposed event date:	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec 2007 2008
Number of Guests Expected:
Nature of Event or Party:
What time would you like your event to start?
Would you lilke food included?	YES NO
What drink package would you like for your event?	Premium Super Premium
Special Needs / Circumstances / Instructions?