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2015-2016 National Performance Series
Season Membership Order Form
Iowa Western Community College
Print name(s) as you would like it/them to appear in the program:
Name(s): ____________________________________________________________________________________________
Address: ____________________________________________________________________________________________
City: ___________________________________________ State: ____________________ Zip: _____________________
Phone: (____)____________________________ Email: ______________________________________________________
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SELECT YOUR SEASON MEMBERSHIP LEVEL:
LEVEL:
QTY.:PRICE: TOTAL:
Youth Series Donation —
Legacy
_____x $5,000.00= $__________
VIP
_____x $2,500.00= $__________
Patron
While selecting your 2015-2016
season membership, please
consider a tax deductible donation
to the Youth Series. Your support
helps the Arts Center provide live
educational art experiences for
area classrooms.
_____x $1,200.00= $__________
Gold
_____
x
$ 600.00
=
$__________
$100.00 sponsors bus
transportation for one class.
Silver
_____
x
$ 350.00
=
$__________
Thank you for your generosity.
Friend
_____
x
$ 180.00
=
$__________
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(30 single tickets)
(20 single tickets)
(20 single tickets)
(10 single tickets)
(10 single tickets)
(6 single tickets)
$50.00 sponsors tickets for
one class.
PICK YOUR SEASON:
Pick any combination of shows as long as your total number of single tickets equals the number of single tickets included in
your selected season membership level above.
SHOW: DATE:TIME:
QTY.:
M-PACT
Sunday, September 27
3:00 pm _____
Becky Martin Big Band
Friday, October 16
7:30 pm _____
Thursday, October 22
7:30 pm _____
Sunday, November 22
2:00 pm _____
Sunday, February 14
7:30 pm _____
Friday, March 11
7:30 pm _____
Saturday, April 9
7:30 pm _____
Bram Stoker’s Dracula
Ballet Nebraska’s The Nutcracker
Rock Legends with Billy McGuigan
Mipso
An Evening with Groucho
over .........u
Iowa Western Community College
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ADDITIONAL MEMBER DISCOUNT TICKETS:
Select all shows you wish to purchase tickets to outside your season membership. Member discount pricing is available
only to season members and only on shows noted below. Ticket service fee is waived for season members.
Additional member priced tickets are available throughout the season by calling the box office.
SHOW:
NO. OF TICKETS:
MEMBER PRICE:
M-PACT
Sun., Sep. 27 @ 3:00 pm
_________
x
$35.00
=
$___________
Becky Martin Big Band
Fri., Oct. 16 @ 7:30 pm
_________
x
$35.00
=
$___________
Bram Stoker’s Dracula
Thur., Oct. 22 @ 7:30 pm
_________
x
$37.00
=
$___________
Rock Legends
with Billy McGuigan
Sun., Feb. 14 @ 7:30 pm
_________
x
$34.00
=
$___________
Mipso
Fri., Mar. 11 @ 7:30 pm
_________
x
$28.00
=
$___________
An Evening with Groucho _________
Sat., Apr. 9 @ 7:30 pm
x
$34.00
=
$___________
Additional Ticket Total Price:
+ season membership total:
+ youth series donation:
$___________
$___________
$___________
Total No. of Additional Tickets: _____
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2015-2016 National Performance Series
Season Membership Order Form
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TOTAL:
GRAND TOTAL DUE:
$___________
PAYMENT METHOD: (Check one)
___ American Express
___ Discover
___ Mastercard
___ Visa
___ Check enclosed
Credit Card Number: ______________________________________ Exp. Date: _________________
Card Holder’s Name: _________________________________________________________________
Card Holder’s Signature: ______________________________________________________________