
Name of Event/Organization:______________________________________________________
Name of Contact:_______________________________________________________________
Performance Site Address:________________________________________________________
Phone: _____________________________ Best Time to Call:___________________________
Performance Date: _______________ Performance Time/Length:_________________________
Description of Performance location (stage, etc.,):______________________________________
Time Site will be available for set up:________________________________________________
Type of event:__________________________________________________________________
Estimated Size of Audience: _______________________
Performance and Technical Requirements (Please check if available):
Dressing rooms available: ____ Yes ____ No
PA system with microphone: _____ Yes _____ No
Piano (tuned and in good working order): _____ Yes _____ No
IF NO PIANO:
Is there access to electrical outlet? _____ Yes _____ No
Is there space to accommodate electric keyboard and stand? ___ Yes ___ No
**PLEASE NOTE ALL PERFORMANCE REQUESTS MUST BE RECEIVED 60 DAYS PRIOR TO EVENT.**