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Teacher's Name: _______________________________________________________

School: ______________________________________________________________

Street: _______________________________________________________________

City: ________________County: ______________ State: _______ ZIP:____________

School Telephone Number: ________________________ FAX: __________________

Home/cell # for weather emergency: ________________________

Signature: _____________________________________________________________

Email Address ________________________ Grade Level: ___________

Theatre or Auditorium	Title of Show........	Show Date	Show Time	# of Paid Students & Chaperones	# of Free Teachers

____ If the earlier performance is sold out, please book my group into the later performance.