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Ticket Reservation Form

All forms of payment must be received
2 weeks prior to performance.
School:
Grade(s):
Address:
City:
State:
Zip:
Teacher's Name:
Contact:
Phone: (School)
Phone: (Home)
Email: (required)
Form of Payment:
Purchase Order #:
 
(If paying by credit card, please phone (606) 677-6000)
Make check payable to (and mail with order form to):

The Center for Rural Development
2292 S. Hwy 27, Suite 300
Somerset, KY 42501
Huck Finn
Tuesday, September 28, 2010 at 10:00 a.m.
Grades 4–8
Time # of Paying Students/Adults Total Due # of Adults
(1 free/10 paid)
Total # Attending
10:00am @ $4.00 ea. $
Disability Accommodation Request:
Cinderella
Friday, October 22, 2010 at 10:00 a.m.
Grades PK–5
Time # of Paying Students/Adults Total Due # of Adults
(1 free/10 paid)
Total # Attending
10:00am @ $4.00 ea. $
Disability Accommodation Request:
'Twas The Night Before Christmas
Monday, November 29, 2010 at 10:00 a.m.
and 12:00 p.m.
Grades K–5
Time # of Paying Students/Adults Total Due # of Adults
(1 free/10 paid)
Total # Attending
10:00am @ $4.00 ea. $
12:00pm @ $4.00 ea. $
Disability Accommodation Request:
Ellis Island
Friday, March 4, 2011 at 10:00 a.m.
Grades 4–9
Time # of Paying Students/Adults Total Due # of Adults
(1 free/10 paid)
Total # Attending
10:00am @ $4.00 ea. $
Disability Accommodation Request:
Out Of The Mist A Dragon
Friday, March 11, 2011 at 10:00 a.m.
Grades 3–8
Time # of Paying Students/Adults Total Due # of Adults
(1 free/10 paid)
Total # Attending
10:00am @ $4.00 ea. $
Disability Accommodation Request:
Peter Rabbit
Thursday, April 7, 2011 at 10:00 a.m.
Grades K–5
Time # of Paying Students/Adults Total Due # of Adults
(1 free/10 paid)
Total # Attending
10:00am @ $4.00 ea. $
Disability Accommodation Request:
If you would like a printout of this form, please use the "print" feature in your browser before submitting the form.
 

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