For facilities with multiple spaces, please complete a separate form for each available space.

Facility Name:*
Space Name:*  

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Street Address:

City:  State: Zip:

Mailing Address:

City:  State: Zip:

Phone:  Fax:

Email Address:*

Website:

Administration

Director/Manager:		Phone:
Booking Contact:		Phone:
Technical Director:		Phone:

Box Office

On Site Box Office	Box Office Phone:
Computerized Box Office	Box Office Software:
Outside Ticket Agency	Agency Name:

Facility Space and Usage

Primary Uses:

Total Seating Capacity:
Number of Removable Seats:
Number of Fixed Seats:

Required Personnel

Required	Provided by Facility	Fee
Stagehands	Stagehands
Ushers	Ushers
Security	Security
Sound	Sound
Light	Light
Box Office	Box Office
Custodial	Custodial
Maintenance	Maintenance

Stage

Stage Type:
Playing Space Dimensions:
Left Wing Dimensions:		Right Wing Dimensions:
Proscenium Opening:		Height Grid/Ceiling:
Stage Floor Type:		Stage Floor Covering:

Permanent Installations on the Deck

Traps in Stage	Orchestral Shell	Other:
Orchestra Pit	Hydraulic Pit	Pit Dimensions:
Electricity in Pit	Music Stands	Number of Stands:
Piano	Chairs for Pit

Backstage

Loading Dock	Door Dimensions:
Number of Dressing Rooms:	Maximum Capacity:

Toilet Access	Shower Access	Mirror Access
Phone Access	Kitchen Backstage	Water Fountain Access

Accessibility

Wheelchair Accessible

Hearing Imparied System

Audio Description

Capacity:   Type of System:  

Rehearsal/Storage Space

Rehearsal Space     Rehearsal Space Floor:
Rehearsal Piano
Mirrors in Rehearsal Space
Storage Space     Dimensions:  

Electric/Sound

Building Electrics Amperage:

Lighting Board:

Space Accommodate Portable Light Board
Follow Spots Available
Renter Can Provide Own Sound Equipment

Parking

Parking Available

Number of Spaces:

Parking Cost:

Lobby

Public Restrooms
Restrooms Wheelchair Accessible
Sell Concessions

Concession Comments:

Sell Alcohol

Alcohol Comments:

Other Charges/Additional Info

Utility Fee:

Insurance Fee:

Additional Info:

Weekdays

Commercial:

Performance Fee:

Rehearsal Fee:    

Non-Profit:

Performance Fee:

Rehearsal Fee:    

Weekends

Commercial:

Performance Fee:

Rehearsal Fee:    

Non-Profit:

Performance Fee:

Rehearsal Fee:    

Respondent Info

Respondent's Name:*

Respondent's Phone:*

* Required field

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