Heroes of the Underground Railroad

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Application for Wednesday, January 24 - 9AM PERFORMANCE ONLY

Name of School/Homeschool/Parent (This is how your reservation will be listed and this is what you will say when inquiring about tickets at the box office)

Street Address

City, State, Zip Code

Primary Contact Person's Name (teacher/parent)

Primary Contact Person's Cell Number

Primary Contact Person's Email Address

Grade Level of Students (put Pre-School for children under 4, or put Pre-K-12th)

How many student tickets? (The cost is $10 per ticket. Do not add teachers, chaperones or adults here, there will be a place for that later)

How many FREE teacher/chaperone tickets? (1 free for every 10 paid students)

How many other additional tickets? (The cost is $10 per ticket. This is for any additional paying adults not included in other tickets)

Total Ticket Cost (Multiply the total number of students and the additional tickets by $10)

Are you applying for a Student Ticket Subsidy Grant with the Tennessee Arts Commission?

Yes

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Deposit Amount Due (15% of the Total Ticket Cost is due at the time of reservation) Individual ticket sales need to be paid in full at time of reservation.

Please choose how you will pay the deposit (your seats are not confirmed until the deposit is paid)

I will call Box Office to pay by phone with Credit Card

I will mail my check to Box Office

I will stop by in person to the Box Office and pay

I have a special situation and will contact the Education Coordinator, Trudy Radford at tradford@dixiepac.net or call 731-986-2100.

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Final Payment Amount Due (the balance remaining after deposit paid - this is due no later than 6 weeks prior to show date) Individual ticket sales need to be paid in full at time of reservation.

List any and all SPECIAL seating needs or accommodations

Number of School Buses expected

I hereby agree to the following: This is a reservation application and my acceptance is based upon the availability of seating, and this is not confirmed until the Dixie Staff contacts me with a reservation number. I understand that there are no refunds or exchanges on ticket purchases. In the event of bad weather, The Dixie (DCPAC) will determine the available course of action with the primary contact. When possible, the show will go on as scheduled. Additional tickets can be purchased if available, however, this must be emailed (tradford@dixiepac.net) or faxed (731-986-0550) to the box office no later than 2 weeks prior to a performance.

Yes

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Submit

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