DW/Pacific Event Request
Store & Contact Information
Store/Event:*
Person Submitting Request:*
Venue Name:*
Venue Street:*
Venue City:*
State/Provence:*
Zip:*
Venue Country: (if outside U.S.)
Contact Person:*
Contact E-mail Address:*
Contact Phone:*
Contact Fax:*
Clinic Request
Artist(s):*
Event Date:*
Event Time (example; 9:30 PM):*
Admission Price:*
Type of event (i.e. Clinic, Masterclass, Festival, Other):
Expected Attendance:
Potential Co-Sponsors:
Event Marketing:
Support Requested (i.e. Financial, Literature, Door Prizes, Banners, Other):
I accept the terms and conditions of the clinics policy