Please complete this form three weeks prior to the event.

Event * Event Date and Time MM / DD / YYYY HH : MM AM PM AM/PM Time Reserved HH : MM AM PM AM/PM Event Est. Length * Sponsoring Group Billing Code * Contact Person * First Last Contact Email * Contact Phone * ### - ### - #### Type of Event * AUDIO/VIDEO MULTIMEDIA EQUIPMENT NEEDED? LOCATION - REQUIRED IF NEEDED ADDITIONAL SPECIFICATIONS Microphones NA Select below... Handheld Lavallere Video Projector No Yes Location pre-set VCR No Yes NA DVD/CD No Yes NA PC Laptop No Yes NA Internet Connection No Yes Cassette Deck No Yes NA EQUIPMENT NEEDED EQUIPMENT NEEDED? LOCATION ADDITIONAL SPECIFICATIONS Podium Select Below... On Stage On Floor Upright Piano Chairs Band Shell No Yes Band Cloud No Yes Conductor Platform Tables STAGING INFORMATION ITEM NEEDED? SPECIFICATIONS Stage Stage only Extension The main stage is 40" high; the stage extension can be adjusted to be 32" and 24." Amount 1 Row 2 Rows 3 Rows Height (inches for each row) Portable Staging No Yes Location Staging Width (ft.) Staging Depth (ft.) Staging Height (in.) Additional Information/Comments Image Verification Please enter the text from the image: [Refresh Image] [What's This?]

Please complete the foyer and stage set-up maps to illustrate positioning of equipment.