STAGE SHOW BOOKING INFORMATION:

To help us provide you with the most appropriate price for your event, please complete and submit this short form with as much information as possible. If you have specific questions, telephone calls are always welcomed.

The following restrictions apply to this offer:

1. Your entertainment budget for any single performance must be at least $250.00  per event or a fundraiser with an anticipated attendance of at least 100 paying patrons. (Fundraisers are generally a 50/50 split of gross receipts. If your organization wishes to employ this method please indicate 50/50 split in the budget line. Call us if you need an exception.)
2. You must expect to make a purchase decision/commitment for your entertainment within the next 6 months. (Contact us if you need an exception.)
3. The event must be occurring within the next 12 months. (Contact us if you need an exception.)
4. A valid contact telephone number and e-mail address are required.
5. Advanced Hypnotherapy Services reserves the right  NOT provide information to any request that they deem questionable.

Thank you.

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First Name
Last Name
Title
Organization
Street Address(to send information)
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail

How did you hear about Advanced Hypnotherapy Services?:

Web  Magazine Ad  Newspaper Ad Yellow Pages  Brochure Word of Mouth  Referral

Which show are you interested in?:

Kenny Cureme, Hypnosis Medicine Show Rex A. Jones, Master Hypnotist 

What is your entertainment Budget?:

Time of event?:

Location of event.

Inside	outside

If outside, Alternate Inside bad weather location:

City:	State:

Occasion/purpose of your event(s).

Attendance estimate:

Average age:

Teen 20's 30's 40's 50's 60+

Tell us a little about the audience,function, and any type of skits you would like to see:

What kind of show would you like:

G-Rated family entertainment PG-Rated 16 and over R-Rated some sexual routines 

G Very clean. Suitable for family or conservative groups. No strong language and little or no sexual dialogue or situations.

PG Mild, adult-oriented subject matter and/or language used in moderation or infrequently.

R Mature adult subject matter and/or language used liberally. Night-club appropriate.

Enter the date of the event :

-- dd/mm/yy

Are you a entertainment agency?

Yes No