First Name *

Last Name *

Organization or Affiliation (if applicable)

Email *

Phone *

Event Name/ Title *

Type of Event (e.g., open mic, fundraiser, conference, school assembly, private event) *

Event Date/ Time

Event Location (in-person: address / virtual: platform & link)

Expected Audience Size

Event Theme or Topic (to tailor the performance)

What type of performance are you requesting? (e.g., Poetry only, Spoken Word, Combination, Workshop + Performance) *

How long would you like the performance to be? (e.g., 10 mins, 30 mins, full set, etc.) *

Will there be other performers or is this a solo feature? *

Are you requesting original work, themed content, or specific pieces? (optional: provide titles or topics) *

Will a mic/sound system be provided? *

Is this a paid opportunity? *

Yes

Let's discuss

Budget/Rate offered (if known): *

Will travel/lodging be provided (for out-of-town events)? *

Will I be allowed to promote or sell merch? *

Do you plan to record or livestream the performance? (If yes, ask: Will I have access to that footage afterward?) *

How did you hear about me? *

Any specific expectations, themes, or messages you want highlighted? *

Other notes/questions/comments?

“I understand that submitting this form does not guarantee a booking and that I will receive a follow-up within 48-72 hours to discuss availability and confirm details.” *

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