Booking Form

Name of Band (required)

Confirmed Date and Time: (if you have confirmed the date with Daniel)

Number of Members (required)

Describe your style of music in 10 words or less :) (required)

Do you plan to charge a cover?

 No cover charge. Other

If other, please specify:

Would you like to hire a door person or bring your own door person? A door person costs $10/hr, $30 minimum.

 We'll bring our own door person (If no cover, choose this option) Hire a door person ($30 minimum)

Would you like to hire a sound person or do the sound yourself from the mixer on stage? A sound person costs $15/hr. They run the sound from the back of the house and will be paid from an hour before the show to 15 minutes after the show ends for setup and take-down time.


 Hire a sound person ($15/hr) We'll do sound ourselves

Please explain how you plan to promote your show and the minimum number of people you expect to draw to the show. We will list your show in the Oregonian, The Mercury, and the Willamette Week. It is up to you to send a press release to these papers.

Your email

Do you have a website we can link to?

Do you have a band photo we can use for our website?

Do you have a YouTube video we can embed on our site?

Do you have a longer bio we could use? Please keep it short; between 3-5 sentences. This information may be used to flesh out the content for our calendar and front page section.

Early shows begin at 6pm and finish by 8pm. Late shows begin at 9pm and must finish no later than 11:15pm (12:15am on Fridays and Saturdays). Please sign below indicating that you understand the start and stop times.

Atlantis Lounge (our full bar) is located at the back of the restaurant and patrons of the lounge must pass through the music room to get to the lounge. If they are not there for the show and just to sit in the Atlantis Lounge, people can pass through the music room without paying a cover. Please let your door person know of this policy if you are providing your own door person. Please sign below indicating that you have read and understood our policy

Our early shows are all-ages and all shows that start at 8pm or later are over-21 shows. Please sign below indicating that you have read and understood our policy.

If charging a cover, you will keep 100% of the door. We also provide each performer with one "drink/pizza ticket" per set played; acts performing two sets receive two tickets per performer. Each ticket is redeemable for a slice, a beer, a well drink, or $4 towards higher end items in the bar. Please sign below indicating that you have read and understood our policy

Load-in times are on hour prior to start times of shows (5pm for 6pm shows and 8pm for 9pm shows). Please check in with the bartender in the back Atlantis Lounge for drink/pizza tickets, mics, etc. when you arrive and she/he will help orient you to our venue. Please keep the level of volume of amps to an appropriate level for the size of our room. The level of volume is ultimately at the discretion of the staff at the Mississippi Pizza Pub. Please sign below indicating that you have read and understood our policy

Additional info/comments

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