Name of School:
_______________________________________

School Rep:
Address:
City:
Postal Code:

________________________________
________________________________
______________________________
________________

Telephone:
Fax:
Email:

(306) __________ - ________________
(306) __________ - ________________ _____________________________________

Performance:
Date:
Time:

________________________________
______________________________
12:30 pm

Previewing Performance: yes / no
Talk Back: yes / no
Tour: yes / no

Ages/Grade:

_________________________

Students
Chaperones
Chaperones
Total

___________@ $7.00 = ____________
___________@ $24 = ____________
___________@ $0.00 = ____________
___________               = ____________

Note: Any changes in numbers must be reported to the Box Office Manager no later than ten days prior to the performance.
No refunds on performance day. Payment is due 10 days in Advance.

__________________________________
Date

__________________________________
Box Office Manager

__________________________________
Date

__________________________________
Representative for School

Please mail or fax this agreement back to Persephone Theatre as soon as possible.
Fax: 306-382-9144
Thank You.