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Name*
First Last
Email*
Phone*
Performance Type*
- Pole
- Chair
- Liquid Motion/Dance
- Other (Please describe below)
Description (if checked the "other" field above)
Is this a group performance?*
- Yes (please tell us how many people will be involved below)
- No
Number of performers (if you checked "yes" above)
Please provide a short description of you performance and what type of music you will be using.*

Maximum 4 minutes! No language restrictions. Edited version of the music must be submitted no later than 7 days before the event.