Your Name:

Your Street Address:

Your Phone:

Your Email:

Serenade Date:

Preferred Serenade Time*:

Full Name of Person To Be Serenaded:

Complete Address of Where Serenade Will Occur

(Street Address, City, State):

Description of Building & Floor Where

Person to Be Serenaded Is Located at Site:

Who Can We Contact at the Site:

What is the Phone Number of the Person WE Can Contact to Coordinate at the Site:

Will You Be Present During the Serenade:

Dedication to be Printed on Card Presented

With Rose (EX: With Love, From Bob):

Questions, Comments, or Special Instructions:

How Did You Hear of Us:

How Will You Pay for Your Singing Valentine:

Referred by a PGS Member? Please Tell Us Who:

Your photo taken at the event will be sent to  the email stated above, unless you designate another here :

Thanks for your interest. We look forward to serving you.

*Performance times shall be within a half hour of the preferred time depending upon demand and logistics.

Once you submit your form, one of our representatives will contact you to answer your questions, and/or discuss payment.