PixelGood.® Web Feature
Design is in the Details.®
Required fields are marked with an
"*"
*
First Name:
*
Last Name:
*
Address:
Address 2:
*
City:
>
*
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
*
Zip:
Country:
UNITED STATES
Home Phone:
(
)
Work Phone:
(
)
*
E-Mail:
Your e-mail address will be used only for WKSU communications.
Payment in full is required and payable by credit card only. We will mail tickets ordered before April 15th. After that date, they will be available at the Highland Theater box office for pick-up.
*
Method of Payment:
Visa
MasterCard
Discover
*
Credit Card Number
:
*
Expiration date
:
Month:
01
02
03
04
05
06
07
08
09
10
11
12
Year:
2001
2002
2003
2004
2005
Number of tickets:
@ $20 each — performance only
Number of tickets:
@ $60 each — reception & performance
Enter the names of your guests below:
Are you currently a member of WKSU?
Yes
No
E-Notes
,
WKSU’s twice-monthly e-mail newsletter gives you timely updates on events, concerts, programs and happenings at WKSU. You can sign-up to receive this e-mail newsletter by checking the box below. This service is free and you may unsubscribe at any time.
Yes, I would like to receive WKSU E-Notes
Your comments are welcome below:
This is a
SECURE
transaction. Click the button
ONE TIME
.
Just ONCE is all it takes to send us your completed registration form.
In actuality, an order really won’t be sent. This is meant to portray the submission process.)
