NASCAM - Live Performance Event License Application

A. EVENT ORGANIZER DETAILS

Organization / Company Name

Contact Person Name

Phone Number

Email Address

Postal Address

B. EVENT DETAILS

Event Name

Venue Name

Town/City

Venue Physical Address

Event Start Date

Event End Date

Estimated Attendance (Please tick one)

0 - 100 people

101 - 500 people

501 - 1,000 people

1,001 - 5,000 people

5,001+ people

Event Type

Charity Event

Commercial Event

Ticket/Event Pricing

Standard Ticket Price (N$)

Note: Additional information may be requested for licensing purposes. This may include playlists of the music to be performed.

C. PERFORMER INFORMATION

Number of Local Performers

Number of International Performers

Required Documentation: Copies of passports for all international performers must be attached to this application.

D. DECLARATION

I declare that the information provided is true and correct.

I understand this application is for a license to publicly perform musical works within NASCAM's repertoire.

Applicant Name

Signature

Date

E. PAYMENT INFORMATION

Banking Details:

Nedbank Namibia

Account Number: 11000017568

Branch Code: 461041 (Maerua Mall Branch)

Please use your full name as payment reference

Note: Proof of payment must be attached to this application form.

NASCAM LIVE PERFORMANCE EVENT LICENSE APPLICATION