Name

Email Address

Phone number (XXX) XXX-XXXX

Name of Organization/Company

Do you have permission to enter into an agreement on behalf of this Organization/Company? Do you have permission to enter into an agreement on behalf of this Organization/Company? Yes No I have permission to request only. Agreement will be entered into by someone else.

Is this Event a fundraiser? Is this Event a fundraiser? Yes No

If yes, please provide the Non-Profit details below. Please include the names of the organization/s the proceeds will benefit.

What is your available budget?

Event Date & Time

Is this Event ticketed? Is this Event ticketed? Yes No

If Yes, please provide the ticket prices.

Select the type of event/performance request Select the type of event/performance request Please check the services being requested so that we can provide you with a correct quote. Event press and meet and greets will be discussed on a case by case basis. Full Character performance (stage play or on camera only) Full Character performance with 1 song (stage play or on camera only) Full Character performance with 2 songs (stage play or on camera only) Event appearance w/crowd address (Party, social function, birthday, etc...) Panel discussion/Fireside chat Keynote speech Stand up comedy set - 30 minutes Stand up comedy set - 45 minutes Walk-Through Appearance Only (presence at an event) Social Media Post (INSTAGRAM) Social Media Post (TIK TOK) Social Media Post (FACEBOOK) Podcast Guest/Host YouTube Advertisement Other

Rehearsal Dates (If applicable)

Venue/Theatre name and address

Venue/Theatre capacity

If requested, in order to for your stage play (movie, etc...) to be considered, you must be willing to send a copy of the script, a clip of the show (if it has already been produced), and photos/plans of the set build.. By checking the box below you are accepting these terms. If requested, in order to for your stage play (movie, etc...) to be considered, you must be willing to send a copy of the script, a clip of the show (if it has already been produced), and photos/plans of the set build.. By checking the box below you are accepting these terms. I agree. I disagree. I cannot agree at this time.

Bookings are not all inclusive. You will be responsible for all arrangements for Patrice Lovely and her assistant (or team, if necessary) according to the agreement. This includes, but is not limited to air travel, ground transportation, and all accommodations. Completing this form is not a contract or a confirmation of an appearance. By checking the box below you are accepting these terms. Bookings are not all inclusive. You will be responsible for all arrangements for Patrice Lovely and her assistant (or team, if necessary) according to the agreement. This includes, but is not limited to air travel, ground transportation, and all accommodations. Completing this form is not a contract or a confirmation of an appearance. By checking the box below you are accepting these terms. I agree. I disagree. I cannot agree at this time.

Please provide any additional details, if applicable