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* 1. What is your name?

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* 2. Are you faculty, staff, student or resident at the School of Dental Medicine?

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* 3. What is your email address?

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* 4. What is your talent?  (Please record it as you'd like it to appear in the program.)

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* 5. What is the name of your group?

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* 6. Who are the other members of your group?  (If affiliated with the dental school, please specificy their role.  Ex. "Chris Klekamp, DS 2016" or "Dr. Dan Wilson, faculty.")

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* 7. What are your AV needs?  (Musicians will need to supply their own instruments and amplifiers, unless they contact us directly.)

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* 8. If you are a musician or a musical group, please specificy the type of amplifier(s) and other equipment you plan on using, and please indicate any backline gear, i.e. monitor rig, amplifiers, drum kits, etc. that you would be willing to use/share.  (***If you are a bass player, please let us know if you have a D.I. box (direct unit) so we won't have to mic your bass rig.)

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* 9. Do you need anything special in terms of stage layout?  (Ex. "Drumset in back, one guitar player on either side, bass player in center with vocal microphone, guitar player on left with vocal microphone.")  Please be specific!

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* 10. In case you need to be contacted the day of the performance, please provide a mobile phone number.

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