UR Medicine / Eastman Performance Medicine / For Patients & Staff / Performance Request Request to Perform in Hospital Spaces Thank you for your interest in performing in our hospital spaces. Please refer to our guide, "Considering the Listeners in the Healthcare Environment" for additional information on performing in the hospital. Ensemble or Individual’s Name: Contact Name: Daytime Phone Number: ( ) - Second three digits Last four digits Email: Program Details: Scheduling Preference - Month: JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Scheduling Preference - Day: MondayTuesdayWednesdayThursdayFridaySaturdaySunday Scheduling Preference - Time (we currently schedule between 10am and 2pm): Stage Needs: ChairsStandsPianoRisersA/V EquipmentOther Is There a Fee for Your Performance?: --Please Select Yes No I Agree to Terms Listed Below: -- Please Select -- Yes No Terms of Agreement I understand that submission of this form does not guarantee a performance opportunity with Eastman Performing Arts Medicine I understand that my music is intended to serve as an inspiration and provide comfort for patients and their families. I also understand that the UR Medical Center and related hospitals are places of solace and my music serves to relieve anxiety of patients and their families during their stay. I understand that I will be asked for my music selections beforehand.