Dysautonomia Foundation Inc

The Paper Bag Players
Sunday, February 13th 2005, 3:00 PM to 4:00 PM
The Symphony Space
2537 Broadway at 95th Street
New York, NY 10025

 
Please fill in the form below, then print this page and send it in with your check.

 All Tickets Will Be Held At The Theatre

$50 Center Orchestra #___of Tickets = $______
$35 Side Orchestra #___of Tickets  = $______
Please accept my additional contribution to benefit the Dysautonomia Foundation $________

Total Order $_________

Name for Box Office Hold____________________________________________

Your Name ______________________________________Phone___________

Address______________________________________________________

City/St/Zip_____________________________________________________

Email ______________________________________________________

Please print this page and send it in with your check.

Please send in your order no later than Feb 5th:
Make Checks Payable to Dysautonomia Foundation
Send checks to:
Dysautonomia Foundation Inc.
633 Third Ave 12th Floor
New York, NY 10017

All Tickets Will Be Held At The Theatre