Performance Request Form

Contact Name  _______________________________________________________ 

Organization (if applicable) ______________________________________________

Phone  _____________________ E-mail  __________________________________

Mailing Address  ___________________________________________________

                   City  _____________________________  State  __________ Zip _____________

Event date  _______________  Time  _____________  Performance Length:  ___________  minutes

Type of event  _________________________________________________________________

Location of event  _________________________________________________

                     City  _____________________________  State  __________

* Please attach directions to event location (from South Riding, VA)

Type of performance (circle all bullets that apply):

• Full company  (10 - 30 dancers, depending on availability, children and adults)

• Children only

• Adults only

• Exhibition only

• Exhibition and audience participation

• Soloist 

• Ceili dance caller with assistants (all audience participation)

   

 Please describe stage or dance area (e.g. dimensions, surface)  ___________________________________

____________________________________________________________________________________

Audience (e.g. approximate size, description)  _________________________________________________

Please circle all bullets that apply:          

• Music source is available for our use
   
  • CD 
  • Cassette tape
  • Live Band

   

• Electric outlet is available for us to run our own sound system

This form may be:

1) Faxed to Denise Fumagali, TCRG at 703-327-6836

                         or

2) Mailed to Denise Fumagali, TCRG

                    25561 Quits Pond Court

                    South Riding, VA 20152