Signatory Contact (Full Name)*

Signatory Email*

Phone Number*

C/O (If Applicable)

C/O Email (If Applicable)

Company Name

Website

Fax Number

Address*

Requested Date*

Performance Time*

Expected Attendance*

Stage Type* (Choose One)
Main StageB StageClubOther
Stage Dimensions*

Set Length*
30 Minutes45 Minutes1 HourOther
If "Other" Please Indicate Set Time

Other Bands Performing*

Event Name

Venue Name*

Venue Address*

Offer Amount in USD (inclusive to travel)