Name:
________________________________________________
Address:
______________________________________________
______________________________________________
Telephone:
Home:
(______)_____________________________
Work:
(______)_____________________________
Email:_________________________________________________
Date:
_________________________________________________
Type
of Membership (Please Circle)
Adult
Student
*Family
* Names of Family Members
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
Total number of members _______
Total renewals _____
Total new subscriptions ____
Additional Donation
$________________ (does not include price of ticket(s) purchased) Patron $25, Donor
$50, Friend $100, Benefactor $250, Corporate
$500, Underwriter $1000.
Total
Amount Enclosed
$______________. Date_________
Checks
should be made payable to the
Clarksville Community Concert Series (or CCS) and mailed with completed membership
application form to P. O. Box 210,
Clarksville, TN 37041.
Reserved
Seating Location
Please indicate on the lines proved your
first and second choice for seating from the
options listed below, or list "keep
same seats as before."
First
Choice:___________________________________________
Second
Choice:
________________________________________
| Orchestra |
Left |
Center |
Right |
| Terrace |
Left |
Center |
Right |
| Balcony |
Side
Left |
Center |
Side
Right |
| Special
Needs |
-- |
Side
Left |
Side
Right |
Mailing
Address
Clarksville Community Concert Artist
Series
P. O. Box 210
Clarksville, TN 37041-210
Telephone
Center of Excellence for the Creative
Arts,
Austin Peay State University (931) 221-7876
or
APSU Music Department (931) 221-7818
Valerie
Oyen-Larsen, Secretary for Membership,
|
