Subscriber Information Form: 3-show Pass

*please print this form first, then fill out and send with cheque to the address below*

Name of each subscriber:

Address:

Postal Code:

Telephone:

E-mail:

Number of Regular Subscriptions: _______ x $57.00: __________

Number of Senior/Student Subscriptions: ________ x $48.00: __________

Please Donate!

For a small company like ours, even the most modest of donations can make a demonstrable difference in allaying production and promotion costs and helping keep our tickets prices reasonable and lots of fun actors on stage! Donors receive a tax receipt for the full amount contributed.

Donation Amount: $ ____________

TOTAL PAYABLE: $ ____________

(GST included in all prices)

Send cheque or money order to:

Teatro La Quindicina

10329 - 83 Avenue, Edmonton, AB T6E 2C6