First Name

Last Name

Name of Organization

Are you the point of contact? Are you the point of contact? Yes No

If not, please provide name, phone number and email address

Mailing Address

Unit #

City

State

Zip

Are you a 501 (c) 3? Are you a 501 (c) 3? Yes No

Federal ID #

Requested Date:

Requested Date – 1st Choice

Requested Date – 2nd Choice

Requested Time (total time including set up & clean up):

Start Time

End Time

Event Type Event TypeMeetingStudio RehearsalAuditionPerformanceMasterclass

Food Service Food Service Yes No

Alcoholic Beverage Service Alcoholic Beverage Service Yes No

Requested Space Requested SpaceStudioPre-Function LoungeCommunity RoomConference Room

Attendance:

Number of Guests (for event)

Number of Participants (for studio)

How did you hear about Dallas Black Dance Theatre?