KIDCARD

Order Form

Complete and mail to:

KIDCARDS @ Little Lake Theatre Co   500 Lakeside Dr. South   Canonsburg, PA 15317

NAME _________________________________________________________________

STREET _______________________________________________________________

CITY ________________________________STATE ______ ZIP __________________

PHONE (______)_________________________________________________________

EMAIL _________________________________________________________________

SELECT:

DAY (WED / FRI / SAT) DATE (Example: 6/24) TIME (11am on Wed only)

                                                                                       DAY          DATE          TIME

CLICK, CLACK, MOO (6/24 - 7/11)       _______     ________      ________

Gooney Bird Greene (7/15 - 8/1)      _______     ________      ________

Give a Mouse a Cookie (8/5 - 8/22)       _______      ________      ________         

Payment by check / VISA or MC

Card # __________________________________________________ Exp. __________

Remember: Parents may purchase KIDCARDS, too.

                                                No. of KIDCARDS __________ @ $20.00 = ________________

                                                                          Tax deductible contribution = ________________    

                                                                                                           TOTAL = _________________