Please print out, fill out and mail to: Northport-East Northport Community Theater
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THEATER WORKSHOP APPLICATION
Tuesday, September 16, 2008 – Thursday, November 13, 2008
(8 Week Session)
Laurel Avenue School, Laurel Avenue, Northport
NAME
______________________________________________________________
ADDRESS
_____________________________________________________________
PHONE ____________________________________________ CELL _________________________________
E-MAIL __________________________________________________
EMERGENCY CONTACT AND PHONE _____________________________________________________
AGE ___________ GRADE (Sept., 2008) __________
PARENTS
’ NAMES _________________________________________________________________________
Please check which session you are interested in attending
Tuesday: 5 – 5:45 ____________ Thursday: 5 – 5:45 _________
6 – 6:45 ____________ 6 – 6:45 _________ (Adult Class)
Fee for the full 8 weeks - $ 150.00
Enclose check or charge and send to: Northport – E. Northport Community Theater
P. O. Box 572, Northport, NY 11768
CHARGE: Visa ______ Card # ___________________________________
Master Card ______ Expiration Date ___________________________
FULL NAME AND FULL ADDRESS (As it appears on credit card)
______________________________________________________________________________
__________________________________________________________________________________________________
P.O. Box 572 , Northport, New York 11768
(631) 896-5970 bdsilver@optonline.net
www.northportcommunitytheater.org