|
Name_________________________________________________________ |
|
Address_______________________________________________________ |
|
City_________________________________State_______ZIP____________ |
| |
| Type of Tickets
Number of Tickets
Price Total |
| Adult Season
________________ X $150.00=
$___________ |
| Adult Season
________________ X $135.00=
$___________ |
| Adult Season
________________ X $ 75.00=
$___________ |
| Student Season
________________ X $ 75.00=
$___________ |
| Student Season
________________ X $ 67.50=
$___________ |
| Student Season
________________ X $ 37.50= $___________ |
| |
| Tax Deductible donation to WVMA
$___________ |
| |
|
Grand Total $___________ |
| |
| Seating Preference (Please be
specific) |
| ( ) Same Seats As Last Year |
| ( ) Main Floor Rows A-Q |
| ( ) Main Floor Rows R-ZZ |
| ( ) Balcony Mezzanine &
Rows AA-JJ |
| ( ) Balcony Rows KK-QQ |
| ( ) Wheelchair Access |
| ( ) Special Needs or
Request |
|
______________________________________________________________ |
|
______________________________________________________________ |
| Method of Payment (
) Cash ( ) Check #
____________ |
| ( ) Visa
( ) MC (
) Discover (
) AmEx |
| Account #
________________________________________ |
| Expiration Date _____/_____
Today's Date ________________________ |
| Signature
______________________________________________________ |
|
For ticket office use only: |
|
Received by _____________________________________ Date Received
___________________ |