“BROADWAY BABES” CREATIVE THEATER WORKSHOPS

REGISTRATION FORM

Name____________________________________________________

Age___    (   ) Male   (   ) Female   Phone # ____________________

Address ___________________________________________________

City _____________________________ State ______  Zip: _________

E-mail______________________________________________

(  ) "ALICE IN WONDERLAND"

                          REGISTRATION FEES @ $350 EACH $ _____

                                                            handling fee = $5.00

                                                                      TOTAL $_____

(  ) Check Enclosed                                   

Charge to:  (  ) Visa   (  )  MasterCard 

Print name on Credit Card: __________________________________

Credit Card Number: ______________________________

Expiration Date: ______/______        Today's Date: ______________

Signature (as on credit card) ________________________________

Mail form to: Westco Productions, 9 Romar Avenue, White Plains, NY 10605