| Name__________________________________________ |
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| Address________________________________________ |
City______________________State___Zip_______ |
| Telephone_______________________________________ |
Email______________________________________ |
Payment Method:
(please circle one) |
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| Check# |
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Please make checks payable to btopaa. |
| VISA |
MC |
AMEX |
Acct#______________________ |
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| Signature________________________________________ |
Expiration Date___/_____ |
| Please circle the date/time you would
like to attend each performance. |
| 2004 Gala of International Ballet
Stars |
| 8/14/04 8:00 PM |
| The Conductors |
| 9/17/04 8:00 PM |
9/18/04 2:00 PM |
9/18/04 8:00 PM |
| Green Legs and Ham |
| 3/4/05 8:00 PM |
3/05/05 2:00 PM |
3/05/05 8:00 PM |
| 2005 Gala of International
Ballet Stars |
| 8/13/05 8:00 PM |
MAIL Order form and payment to:
ballet tech ohio performing
arts association
7623 Old 3C Highway
Maineville, OH 45039
FAX Order form to: 513.583.5620
(Day or Night - Credit Cards Only)
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| _____#@71.00 = |
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| _____#@81.00 = |
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| _____#@91.00 = |
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| _____#@101.00 = |
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| _____#@121.00 = |
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| _____#@141.00 = |
________________ |
I would like to give a charitable
donation to ballet
tech ohio performing arts association |
| Corporate $1000 |
________________ |
| Benefactor $500 |
________________ |
| Soloist $250 |
________________ |
| Corps de Ballet $100 |
________________ |
| Balletomane $50 |
________________ |
| Toe Shoe $25 |
________________ |
| Dance 2 Community Kids $20 (per sponsored child) |
________________ |
| Total = |
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