Request for Booking a Performance with Magic Hips

Name *
Email *
Phone *
I am a: *
Event Type *
*Event Type NOT listed above: Please indicate type of Event (*sorry no all-male parties)
Date of Event *

MM
/
DD
/
YYYY
Requested Performance Start Time *

HH
:
MM

AM/PM
Venue Name / Event Address *

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
# of Guests Expected
Performance Type *
Is the performance area
Please Describe Performance Area:
Upon availability, Would you like to request a Tabla Player to play for the Dancer during her performance set?
*The Fee for Tabla Player is in addition to the dancer's fee*
$50 for Tabla Player for Mini-Show
$70 for Tabla Player for Standard Show
 Yes 
 No 
Please indicate the Heritage/cultural diversity of the audience to aid in selection of music for performance:
Special Requests/Questions/Comments:
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