Performance Request Form

Event Name

Event Date

Event Time

Venue

Venue Address

Venue Location

Inside
Outside

Contact Person at Venue on Performance Date

Name

Phone

Composition of Audience

Size of Audience

Age Range

Performance Information

Description of your performance request (please be as specific as possible)

Length of Performance

15 minutes
30 minutes
1 hour
90 minutes
2 hours

Other Services

Workshop/Seminar
Orientation
Training

College Tour

Laughing Out Loud
The Adventures of Condom Man
All My Black Children
Spoken Roots

Other (please be as specific as possible)

Requester

Name

Company

Address

Phone 1 #

Phone 2 #

Fax #

Security Code