
| Name ________________________________________________ |
| Address ______________________________________________ |
| City/State/Zip__________________________________________ |
| Phone ________________________________________________ |
| E-mail ________________________________________________ |
| General Public | $45 | X | _____ | = | $ _______ |
| UWL Student | $15 | X | _____ | = | $ _______ |
| Senior Citizen | $35 | X | _____ | = | $ _______ |
| Non UWL Student | $35 | X | _____ | = | $ _______ |
| Grand Total | $ _______ | ||||
Payment Method____Visa ____ Mastercard
____ Check Enclosed (Payable to UWL Theatre) |
| Card Number _____________________________________ |
| Expiration Date ___________________________________ |
| Signature_________________________________________ |
| Date ____________________________________________ |
Order
by Mail
|
Order by
Phone
|