PERFORMANCE REQUEST FORM
( simply print out the form, fill it out and mail it or fax it back to us)

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

Performance Fee: Amount: _____________Form of Payment: ________________________

**PLEASE NOTE ALL PERFORMANCE REQUESTS MUST BE RECEIVED 60 DAYS PRIOR TO EVENT.**