Name:     ____________________________________________________________________________________

Address: ____________________________________________________________________________________

Phone:     ____________________________________________________________________________________

Email:     ____________________________________________________________________________________

Type of Event: _____________________________________________________________________________

Date of Event: _____________________________________________________________________________

Time of Performance: _______________________________________________________________________

Length of Performance: _____________________________________________________________________

Event Location: ___________________________________________________________________________

Event Address: ___________________________________________________________________________

Event Telephone: __________________________________________________________________________

Event Contact: ____________________________________________________________________________

Directions to Event & Other information:

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Number of Performers:     __________

Length of Performance:     __________ [1 "Set" is approximately 15 minutes or 4 songs]

Additional Fees:                 __________ [May apply in case of overnight stay and extended travel]

Total:                                     __________

Signature below constitutes agreement to the above and to the attached terms:

_____________________________                                             _____________________________

Purchaser                                                                                             Traveling Hips Representative

Thank you for choosing Traveling Hips Belly Dance! We have just a few requirements and terms in order to make your performance as safe and enjoyable as possible.

• We provide family entertainment only. ** Handling of the dancers is NOT permitted. If the audience gets out of control; offending parties will be removed or the dancers will end the show. No fees will be refunded.

• Please provide a clean safe dance area. The dancers may be barefoot so please make sure the floor is clean from debris and obstructions. Make sure all animals are secured. Any outdoor performances must be conducted in a safe manner and there must be an indoor rain contingency plan.

• Each Performer is accompanied by an assistant. Payment is due to the assistant before the performance begins. Please specify if the assistant needs to bring a CD player for music or any other props or equipment.

• For Cancellations please contact Traveling Hips immediately. Failure to do so within 5 days of event will result in a 20% cancellation charge, and a 50% cancellation fee for cancellations less than 48 hours prior to performance.

• A Non Refundable Reservation Fee is due at the time of scheduling of the performance. When booking by phone Traveling Hips will hold your event date & time for TWO WEEKS at which if the Performance Contract is not returned with the Reservation Fee, we will consider the booking canceled.

• Purchaser agrees to be responsible for the actions of the Purchaser's employees and patrons, and to reimburse Traveling Hips Belly Dance Performers for any damages suffered due to the actions of the Purchaser's employees or patrons, including harm to any costumes, props or equipment while such items are at the place of the performance.

• The recording, reproduction, filming or transmissions of any Traveling Hips Belly Dance performances are prohibited without the written consent of the Performer(s). Traveling Hips Belly Dance agrees that the Purchaser shall have the right to use the Performer's name, approved pictures, and other likenesses in connection with the advertising and publicizing of the engagement hereunder, but such use shall not be as an endorsement of any product or service, or for the sale of any merchandise, except with the Performer's written permission. Full Photo Rights ARE / ARE NOT granted for any photos taken during the above engagement.