EA Pro Music Information Request Form
Date Of Event*	MonthJanuary (1)February (2)March (3)April (4)May (5)June (6)July (7)August (8)September (9)October (10)November (11)December (12) Day12345678910111213141516171819202122232425262728293031 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050
First Name*
Last Name*
Email Address*
Mailing Address*
Mailing Address Line 2
City*
State*	select state or provinceAlabamaAlbertaAlaskaArizonaArkansasBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundlandNorth CarolinaNorth DakotaNW Territories/NVTNova ScotiaOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingYukon
Zipcode*
Cell Number*
Event Location (Venue)*	Please Select A Venue... Amish Acres - Nappanee, Apple Blossom Resort - New Buffalo, MI Auction Barn Baker Street Station - Fort Wayne, IN Balmore house - Fishers, IN Bel Air - kokomo, IN Bethel College BK Club - Mishawaka, IN Black Forty - Bourbon, IN Blank Space - Goshen, IN Blue Barn Berry Farm - Syracuse, IN Bread & Chocolate - Goshen, CE National - Winona Lake, IN Celebrations Palace - Mishawaka, IN Center SIx One Five - Elkhart, IN Century Center - South Bend, IN Ceruti's Banquet & Events Ceneter - Fort Wayne, IN Christiana Creek Country Club - Elkhart, IN Christos Banquet Center - Plymouth, Conservation Clubhouse - Plymouth, IN Double Tree Hotel - South Bend, IN Elkhart County 4-H Fair Ground - Goshen, IN Fairfield Inn & Suites Elkhart - Elkhart, IN Farmstead Inn, and Conference Center - Shipshewana, IN Four Winds Casino Resort - New Buffalo, MI Fraternal Order of Eagles - South Bend, Fraternal Order of Police Lodge 91 - Mishawka Indiana, IN Goeglein's - Fort Wayne, IN Goodsen Street Event Center - South Bend, IN Goshen Brewing Company Goshen College - Goshen, IN Goshen Theater - Goshen, IN Harbor Shores Golf Course - Benton Harbor, MI Head Waters Park - Fort Wayne, IN Hedwig Memorial Center - South Bend, IN Heritage Room - Winona Lake, Heston Hills Event Center - La Porte, IN High Dive Pavilion - Elkhart, IN Izaak Walton League - South bend, IN Knights of Columbus | Mishawaka - Mishawaka, IN Knights Of Columbus | Plymouth - Plymouth, IN Knollwood Country Club - Granger, IN La Porte Civic Auditorium - La Porte, IN Lahr Atrium - Lafayette, IN Lakeside Occasion - Topeka, IN Lakeside Park & Rose Garden - Fort Wayne, IN Matterhorn - Elkhart, IN Meadowbrook Barn - Goshen, IN Monroe's Crossing - New Carlisle, IN Morris Estate River House - Niles, MI Morris Estate Supper Club - Niles, IN Mt. Vernon High School - Fortville, IN Nelson's Banquet Hall - Wakarusa, IN Oakwood Resort - Syracuse, IN Old Train Depot - Pierceton IN, IN Orchard Ridge Country Club - Fort Wayne, IN Palais Royale - South Bend, IN Patchwork Quilt Inn - Middlebury, IN Potawatomi Conservatories - South Bend, IN Red Barn - Upland, IN Red Tail Farm - Goshen, Riverside Terrace - Mishawaka, IN Rock Run Creek Barn - Goshen, IN Smitty Mcmusselman's Pub & Grub - Peru, IN Spohn Ballroom - Goshen, IN St Andrews Greek Orthodox Church - South Bend, IN St Joe Farm - Granger, IN St. Hedwig's Memorial Center - south bend, IN St. Joseph County Grange Fairgrounds - Centreville, MI Stonehenge Country Club - Winona, IN Studebaker Park - Elkhart, IN Swan Lake Resort - Plymouth, IN Sylvan Cellars - Rome City, IN TBD The Allure - Laporte, IN The American Legion - Middleburry, The Armory - South Bend, IN The Blue Heron at Blackhorn - South Bend, IN The Collective - St. Joseph, MI The Exchange - South Bend, IN The Farm House - napanee, IN The Freemasons Hall - Fort Wayne, IN The Homestead 1835 - New Carlisle, IN The Landing - South Bend, IN The Oaks at Southpaw Farm - Mishawaka, IN The Summit - Fort Wayne, IN The Veranda at Whitcomb - St Joseph, MI The Woodward Room - South Bend, IN Three Oaks Social Club - Three Oaks, MI Tippecanoe Lake Country Club - Leesburg, IN Turner Hall Ballroom - Milwaukee, WI University of Notre Dame - South Bend, IN University of Saint Francis - Fort Wayne, IN Uptown Center Performing Arts - Michigan City, IN Waterford Estates Lodge - South Bend, IN Wellfield Botanic Gardens - Elkhart, IN Windsore Park - Mishawaka, IN ZB Falcons - South Bend, IN
(if your event location is not listed above please fill in the following...)
Event Location (venue)
Event Location (city)
Event Location (State)	select state or provinceAlabamaAlbertaAlaskaArizonaArkansasBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundlandNorth CarolinaNorth DakotaNW Territories/NVTNova ScotiaOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingYukon
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Fiancé First Name
Fiancé Last Name
Fiancé Email
Fiancé Telephone
If this is a wedding please check one	We need DJ services for our ceremony We don't DJ services for our ceremony
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