Events Order Form - DOC by hcu63244

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									       NYS ADTA Dance Concert Order Form

             Presence: The Creativity of
            Dance/Movement Therapists
                           Saturday, November 6, 2010
                                    TADA! Theater
                                    15 West 28th St.
                                  New York, NY 10001
                                       @7:30pm
Date: ______________

Name: _______________________________________

Email: ______________________________________

Phone Number: _______________________________

Student Rate- $15.00                                                      Quantity _____
Member Rate- $20.00                                                       Quantity _____
Non-member Rate- $25.00                                                   Quantity _____

                                                                     Total Tickets _____
                                                                     Total Price $_____

Mail your completed order form with a check made out to NYS ADTA to:
Elisabeth Grasberger
600 Jackson St. Apt. 401E
Hoboken, NJ 07030

* Please do not send in orders after Wednesday, October 27, 2010
*Your ticket(s) will be emailed to you. Please bring a printed or electronic ticket with
you, along with a photo ID. Admission will not be granted without ticket.


                                For Internal Use Only

___ Cash      ____ Check        ____ Check #           Date Ticket Emailed _______

								
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