CONTACT INFORMATION:

FIRST NAME:       LAST NAME: 

ADDRESS:      CITY:       STATE:       ZIP: 

PRIMARY PHONE:       ALT PHONE: 

E-MAIL ADDRESS: 

EVENT / SHOW INFORMATION:

DATE OF EVENT / SHOW:  JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 , 2008 2009 2010       TYPE OF EVENT:  BAR / CLUB CASINO CORPORATE EVENT STREET DANCE WEDDING FAIR OTHER   IF OTHER, EXPLAIN IN COMMENT BOX BELOW.

 BAND START TIME:  1 2 3 4 5 6 7 8 9 10 11 12 : 00 30   AM PM      BAND END TIME:   1 2 3 4 5 6 7 8 9 10 11 12 : 00 30   AM PM

NAME OF VENUE: 

CITY OF VENUE:       STATE OF VENUE: 

STAGE LOCATION:  INDOORS OUTDOORS      IF OUTDOORS, IS THE STAGE COVERED:  YES NO

HOW MANY PEOPLE ARE YOU EXPECTING AT THIS SHOW:     TO 

WHAT IS YOUR NORMAL PRICE RANGE FOR BOOKING ENTERTAINMENT:  $  TO  $

HOW MANY TIMES HAVE YOU SEEN US BEFORE:  0 1 2 3 4 5+

DID SOMEONE RECOMMEND US TO YOU?  IF SO, WHO: 

COMMENTS: