APPLICANT

Your Name (Last, First)

Your Personal Email

Your position/title/role with the facility:
Sole OwnerPartnerOperatorManagerOther

Your direct telephone number. Please use this format (xxx) xxx-xxxx

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THE FACILITY

The name of your facility:

Street address of your facility:

Quadrant of the City: NENWSESW

Postal code of facility:

The type of facility:barclubhotelnightclubpubrestauranttavernother

Seating capacity:

Facility's web site (Skip this item if there is no web site.):

Facility's telephone number. Please use this format (xxx) xxx-xxxx

The facility's email address:

On site food options: (Check all that apply.) nonepre-packaged foods (e.g, potato chips, etc.)order inbar foodfull dining menu

Is there an existing dance floor? (Select all that apply.)YesNoRequires moving tables

Is there an existing stage? Yes, it's permanentNoIt's portable

Can musical equipment be loaded in and out without disturbing clientele? YesNo

Is free parking available? YesNo

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THE BOOMER DANCE PARTY AGREEMENT

Are you authorized to engage in contractual agreements concerning the above noted facility?
YesNoConditions apply

Can you provide free admission during Boomer Dance Party events?
YesNoRequires discussion

Will monthly advance payments work with your existing accounting procedures? YesNoPossibly

Your preferred method of payment: Electronic - funds transferCredit card (via PayPal)Other

If "other", please state your preferred method:

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START DATE

Please indicate the date you could be ready to hold your first Boomer Dance Party:

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IN ADDITION

Questions or Concerns? (Skip this item if you have no questions or concerns.)

Send any pictures you would like posted on the BoomerDanceParty.ca website to: boomer@helpmetrics.ca

Thank you for your time and careful attention.