Cosmic Chaos Amateur Night Submission Form
Stage Name
*
First Name
Last Name
Legal Name
*
First Name
Last Name
Preferred Pronouns
Contact Email
*
Social Media Handle(s)
*
Act Description:
Costume colors, energy, inspiration, etc.
Music
*
Please provide song name and length
Act Video
Browse Files
If available, if not please upload 1 performance clip
Cancel
of
Promo Photo
Browse Files
Cancel
of
What is the inspiration behind your stage name or why you became a performer?
We want to know more about you!
Anything else you want to tell us?
I understand that the results of this application are randomly chosen.
I confirm.
I understand that should I be chosen, “messy” performances are NOT allowed. (I.E. wax, glitter dumps, liquid pours, etc.)
I confirm
I confirm that I am not currently part of a burlesque “troupe” and have 2 years or less of experience.
I confirm
Signature
Please sign your legal name
Submit
Should be Empty: