Book-to-Stage Rights Request Form

* indicates required field

Producer Information

Contact Name*

Your Title

Your Email*

Producing Organization*

Contact Address

Address 1*

Address 2

City*, State* Zip*

Telephone*

Website

Name, Title, and Email of party signing the contract

Name*

Title*

Email*

Rights Request

Type of Inquiry*

ProfessionalAmateurPuppet

If Professional, specify your Equity contract:

Is this for a Contest, Festival, or Conference performance?

YesNo

If Yes, please list your sponsoring organization:

Briefly describe the length and requirements of the cutting requested (if you will be performing the entire show, please state 'entire show'):

Book Requested*

Book Author(s)*

Adaptor(s)

Additional Comments:

Production Information

Number of Public Performances*

Number of School Performances*

Dates (MM/DD/YY) - (MM/DD/YY)*

Performance Venue*

Venue Address*

Address 1*

Address 2

City* , State* Zip Code*

Telephone*

Number of Seats:

Average Ticket Price (USD$): $ .00

What is the average expected percentage (%) of seats to be sold at each performance (estimate, of course): %

Do you pay your actors?*

If yes, what is their weekly salary?
$

Is this production in English?

YesNo

If No, then what language will you perform in?

Is this a musical?

YesNo

If Yes, will you use...

PianoOrchestrationsOrchestral CD

Rental period (prior to the opening date)

Please list the last 3 shows performed and royalty paid (per performance or % of gross): (e.g. AS YOU LIKE IT, $100/performance)

Show: / Gross $.00

Additional comments:

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