UCLA
GLUCK FELLOWS MUSIC PERFORMANCE PROGRAM
2007-2008

Department of Music * Box 951616 * Los Angeles, CA 90095-1616 * (310) 825-8628 * (310) 206-4738--fax * musicoutreach@arts.ucla.edu


PERFORMANCE REQUEST FORM
When completed, please click "Submit" at bottom of form

Site Name:

Site Description (School, Nursing Home, etc.):

Address:

City: State: Zip:

Site Phone: - - Fax: - -

Contact Name:

Contact Phone: - - Email:

Requested Date(s)*: Times:

Times:

Times:

Performance Space Description:

Equipment Loading Specifications:

Piano: Yes No (Check yes or no). If yes, check Upright Grand --Date of last tuning

Anticipated audience size: Reason for Performance:

Please provide a brief description of your goals for a Gluck Fellows performance (i.e., how you feel the music will impact your program; how you expect the music to benefit the audience, etc.)

*Performances may not be used for benefits, fundraisers, or other social functions where the performers are not the primary focus of the audience.

--Please include proof of non-profit status with application.

*While every effort will be made to satisfy your request, not all performance dates/times can be accommodated. You will be updated regarding the status of your request within two weeks of submitting this application.