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Community Outreach Performance Request Form

Enter your information in the boxes below (fields marked * are required).

Organization Information

*Organization Name:

*Street Address:

*City:

*State:

*ZIP (Postal) Code:

Please tell us about your organization, its mission and programs.

Contact Information

Primary Contact

*First name:

*Last name:

*Phone:  XXX-XXX-XXXX

*Email Address:

Additional Contact

Name:

Phone:  XXX-XXX-XXXX

Email Address:

About your performance space

Where will the performance be held?
Auditorium
Cafeteria
Lobby
Classroom
Other  

Is there a stage?
Yes    No

Is there a piano?
Yes    No

If yes, what type of piano?
Grand
Upright
Electric
Other  

Is the piano kept in tune?
Yes    No

Is there a public-address system?
Yes    No

About your audience

Does your audience represent any of the following demographics?
(check all that apply)
K-12
Senior citizen
Culturally underserved
Economically disadvantaged
Incarcerated
Shut-in due to illness
Other  

How many people are expected to attend?
fewer than 30
30-49
50-99
100-200
200+

What type of concert is preferred?
Vocal
Instrumental
Dance
Dramatic
Other  

What type of music is preferred?
Classical
Broadway
Jazz
Opera
Solo
Chamber
Other  

Additional Information

How did you hear about us?
Website
Flyer
Brochure
Social media
U-M faculty
U-M student
Other  

Does your organization plan to record or photograph the performance?
Yes    No

Will your recording or photos be made available to Youth & Adult Programs or the student(s)?
Yes    No

Are you able to offer an honorarium?
SMTD Youth & Adult Programs area provides outreach performances to the community free of charge. While student performers are not paid for performances, we believe that students should not incur expenses while providing this community service. Community financial support, at any level, allows us to reimburse student performers for personal expenses such as mileage, car rental and accompanist fees. Honorariums and donations are accepted and appreciated and may be sent to Youth & Adult Community Programs - Outreach.
Yes    No

*Photo Disclaimer
Organization participation in Youth & Adult Programs sponsored Outreach Performance Series events authorizes the School of Music, Theatre & Dance, its employees, and contractors to take photos and videos of your facility and audience for use in future brochures, flyers, documents, displays, in other University of Michigan publications, on the SMTD website, and social networking websites. The Regents of the University of Michigan, the School of Music, Theatre & Dance, Youth & Adult Programs, or their legal representative retain the copyright in the sound and/or video recording of the musical work.
I certify that I have read and understand these statements in their entirety.

Would you like to be added to the Youth & Adult Programs mail list to receive information about future programs?
Yes    No



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Photography Credits:

U-M Photo Services

Joe Welsh

Peter Smith

David Smith

Glen Behring

Tom Bower

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