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

Name of Event/Organization:______________________________________________________

Contact Name:_________________________________________________________________

Performance Site Address:________________________________________________________

Phone: _____________________________ Best Time to Call:___________________________

Performance Date: __________________________ Time/Length:_________________________

Description of Performance Location:_______________________________________________

Time Site will be available for set up:________________________________________________

Type of event:__________________________________________________________________

Estimated Size of Audience: _______________________________________________________

Performance and Technical Requirements (Please check if available):

Dress Rooms: ____ Yes ____ No

PA system with Microphone(s): _____ 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.**