| School Name | |
| Full Address | |
| School Phone | ( ) |
| Contact Teacher's Email | |
| Contact Teacher's Name | |
| Teacher Cell Phone # (someone who will be on the trip) | |
| Other Teachers' Names | |
| Date of show | Time | ||
| Theater | Neumann | St. Joseph | |
| (Circle one) | |||
| # Students | # Teachers | ||
| # Chaperones | # Classes | ||
| Deposit Amount Enclosed $ | |
| ($1.00 PER TICKET - Classroom personnel free) | |
|
Mail form and deposit to: Stages of Imagination 648 N. Lemon St. Media, PA 19063 Make checks payable to Stages of Imagination |