Booking Request Form
*Required Fields
Contact Information
*Your name:
Email:
Company:
*Daytime Phone #:
Evening Phone #:
Best Contact Times:
Event Information
*Pick Performer you wish to book:
*Event Type:
*Event Date(s):
Start Time:
 End Time:
* Event Description
(Please be as detailed as possible).  
Include the following:
Number of Guests
Theme of the event
Duration of event
If you Chose Other in Event Type, please specify
What type of event (i.e.birthday party, company party, etc.)
Include any specific questions particular to your event
Describe the location and accommodations available
Bookable Services and Request Form
Private Lessons - individual and group

"The MadIam" offers individual private lessons in Tribal Belly Dancing, Burlesque,
SWORD'elesque and TRIB'elesque and many other dance styles.  

She offers private lessons for individuals or groups.

Her classes are a great and fun team builder for co-workers or to help you prepare for a special
occasion for someone special. Rates are dependent on group size, duration of lessons and
location.  Please submit your request so that we can offer you the best package available.

Party / Conventions / Restaurants / Shows

"The MadIam" and / or The Dames du Ventre offer a variety of performance options based on the
needs of your event.  She will work with you to individualize each performance to be unique to
your event.  

Performance rates will be based on the needs of your events, duration and number of performers
you wish to book.  Please submit your request below so that we can offer you the best package
available.

For information on The Sexy Scallywags, please visit their website at
www.sexyscallywags.com and contact Samantha for information.

Styles and Prop Options

TRIB'elesque
SWORD'elesque
Tribal Belly Dancing
Sword / Boa
Fans
Palm Flames
Veil and Double Veil