DW/Pacific Event Request
Store & Contact Information
Store/Event:
*
Person Submitting Request:
*
Venue Name:
*
Venue Street:
*
Venue City:
*
State/Provence:*
*
International
AB
AL
AR
AK
AZ
BC
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
MB
ME
MD
MA
MI
MS
MO
MN
MT
NB
NE
NV
NF
NH
NJ
NM
NY
NC
ND
OH
ON
OK
OR
PA
PQ
SC
SD
SK
TN
TX
UT
VT
VA
WA
WI
WY
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