MEDWAY CULTURAL COUNCIL
                              155 Village Street
                               Medway, MA 02053



                             PERFORMANCE AGREEMENT
                             _____________________



A performance by _____________________________________ has taken place
                             Applicant


at ___________________________________________________________________
                        Place of performance


for __________________________________________________________________
       Client (school, library, senior center, civic organization)


on ______________________________ at _________________________________
             Date                                Time


________________________________
Number of persons served


__$_____________________________
Grant amount due to applicant



________________________________
Client Signature


________________________________  _______________
Performer Signature                    Date



THIS DOCUMENT MUST ACCOMPANY ALL REQUESTS FOR REIMBURSEMENT, ALONG WITH
THE MASSACHUSETTS CULTURAL COUNCIL'S REIMBURSEMENT FORM LETTER.