SCHOOL INFORMATION

 

School Name: ___________________________________________________________________________

 

Principal: _______________________________________________________________________________

 

Street Address: __________________________________________________________________________

 

County: ______________________________________  District: ___________________________________

 

City: _____________________________________ State: ________________________ Zip: _____________

 

Phone: (      ) _____________________________ Fax: (       ) ______________________________________

 

 

CONTACT INFORMATION

 

Contact Name: ______________________________ Title: _________________ Phone: (      )____________

 

Mailing Address: __________________________________________________________________________

 

Fax: (      ) _____________________________ Email: ___________________________________________

 

Mail Invoice to:  ______ School or _______Contact Person

 

Funding Source if applicable: _______________________________________ Amount: $ _______________

 

Notes: _________________________________________________________________________________

 

 

REQUESTED PROGRAMS    Are you requesting 1 program? ____   Or, all? ____

 

1) Ensemble__________________________ Program _____________________  Times___________  am  pm

 

Date: 1^st choice _______   2^nd choice _______   3^rd choice_______  Audience. Size_______  Grade levels_____

 

Single:_____    2 back-to-back:______   Workshop:_____    # of Workshops:_______    Residency: _______

 

 

2) Ensemble__________________________ Program _____________________  Times___________  am  pm

 

Date: 1^st choice _______   2^nd choice _______   3^rd choice_______  Audience. Size_______  Grade levels_____

 

Single:_____    2 back-to-back:______   Workshop:_____    # of Workshops:_______    Residency: _______

 

 

3) Ensemble__________________________ Program _____________________  Times___________  am  pm

 

Date: 1^st choice _______   2^nd choice _______   3^rd choice_______  Audience. Size_______  Grade levels_____

 

Single:_____    2 back-to-back:______   Workshop:_____    # of Workshops:_______    Residency: _______

 

 

                                                           Please fax to (215) 772-0464 or mail to:

                    Young Audiences of Eastern PA, PO Box 4095, Philadelphia, PA 19118

 

Please allow 2-3 weeks to process this form, after which we’ll mail or fax you a program agreement, which also serves as your invoice.