Scorpion Disco
Information Request Form
Date Of Event* 
First Name* 
Last Name* 
Email Address* 
Event Start Time 
Event End Time 
Event Location (venue)* 
(if your event location is not listed above please fill in the following...)
Event Location (venue) 
Event Location (city) 
Type Of Event* 
How did you hear about us?
Are You Interested In A Payment Plan?* 
Are You Interested In Our 4ft Love Letters?
Would You Like A Fog Machine? (Free Addon)
Does The Venue Have Stairs To The Area Of Setup?* 
Have You Checked The Handy Date Checker On The Home Page?* 
(Click To View)
* required fields