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| Rental Form Organization _______________________________________________ Address ___________________________________________________ City __________ State _______________ Zip ____________________ Phone _______________________ Email ________________________ Fax _________________________ Contact Person _____________________________________________ Applicant is: For-Profit Corporation Partnership 501(c)(3) Nonprofit Corporation Individual Proposed Performance ____________________________________________ Opening Act _____________________________________________________ Intermission? yes no
Hold from sale: On Sale Date:
Submission of an application does not grant or imply an agreement to use the Count Basie Theatre. Only when a License Agreement has been fully executed is an agreement in place. Applicant acknowledges that application will be reviewed and that additional information, documentation or references may be requested. When and if this application is approved, Count Basie Theatre will hold the date(s) approved for up to fourteen (14) days, at which time if applicant has not confirmed the dates, the dates may automatically be released. If another party should inquire about dates before applicant has confirmed dates, applicant shall have forty-eight hours from such notification by Count Basie Theatre to confirm or release dates. Signature ___________________________________________________________ Date __________ Count Basie Theatre Use: Approved and holding Date Not Approved ___________ Initials |
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