POLE PARTY REQUEST FORM

First and Last Name *
Phone number *
Your E-mail address *
Street Address *
City *
State and Zip *
Type Of Party Bachelorette, Birthday, Girls Night Out. ETC
Guest of Honor
Exact Day and Date of Party *
Party Start Time *
Party End Time ( Parties are 1,2,3 or 4 hours no half hour increments.
Will your party be at 1807 Chestnut Studio --4 poles *	Yes No
Will your party be at 1520 Sansom Studio --14 poles *	Yes No
Will this party be at a residence, hotel or banquet hall *	Yes No
If this party is at a house or other location please provide the complete street address with City, State and Zip
Maximum Number of Guests You Expect *
Do you have a favorite party instructor / host.	Yes No
If yes Please give us their name.
Do you understand a deposit is required to confirm this request. You must select 'YES" *	Yes No
Do you have specific requests or questions ?