Student Matinee Reservation Request Form Reservation Request form for Student Matinee Series showtimes What show are you reserving tickets for?(Required)The Old Man and the Old MoonWe're sorry, but reservations have closed for this production. Please select a different show.Teacher Name(Required) Discipline/Class(Required) School Name(Required) Grade Level(s) Attending(Required) School Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code School County(Required) Email(Required) School Phone #(Required)School Fax #Mobile Phone #(Required)To be used for emergencies and/or day of show information.Are you a Title 1 School? Yes, Title 1 No Would you like to attend the post-show talk-back conversation with the cast? Yes No Unsure Choice of DatesWe will make every effort to seat your group on the requested date, but if we can’t, we will aim for one of your alternate dates. We cannot guarantee that all groups will be seated on their requested dates. Selecting only one date will reduce your likelihood of a reservation.First Choice(Required)March 15 at 10amMarch 17 at 10amMarch 22 at 10amMarch 24 at 10amSecond ChoiceMarch 15 at 10amMarch 17 at 10amMarch 22 at 10amMarch 24 at 10amThird ChoiceMarch 15 at 10amMarch 17 at 10amMarch 22 at 10amMarch 24 at 10amFirst Choice(Required)May 12 at 10amMay 17 at 10amMay 19 at 10amSecond ChoiceMay 12 at 10amMay 17 at 10amMay 19 at 10amThird ChoiceMay 12 at 10amMay 17 at 10amMay 19 at 10amAccessibility Requests(i.e. Accessible seating, ASL Interpreter, Braille program or other). Ticket Quantity + CostOne chaperone is free with every 10 tickets for groups with fewer than 100 students (10 student tickets + 1 free chaperone) One chaperone free with every 20 tickets for groups with over 100 students. (20 student tickets + 1 free chaperone)# of student tickets Price: $10.00 Quantity: # of free chaperone tickets Price: $0.00 Quantity: # of addl. chaperones Price: $10.00 Quantity: Total We will contact you if all of your selected performances are sold out.Any questions or comments? Thank you! When you submit this form, a copy of your responses will be sent to your email.Further questions? Contact Melinda McCrary, Director of Education and Community Programs at firstname.lastname@example.org or 816-235-5708.