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Imperial Theatre Box Office
P.O. Box 43, Sarnia, Ontario N7T 7H8 Canada

OR....Call, fax, or bring to the box office

Name(s)** __________________________________________________

__________________________________________________________

Address ___________________________________________________

City _________________________  Prov/State ____________________

Code/Zip  ____________________  Phone (_____) _________________

Email ______________________________________________________

Method of Payment:
1. (_) Cash or Debit (in person only)
2. (_) Cheque (payable to Imperial Theatre Box Office)
3. (_) Visa    (_) MasterCard      (_) American Express

Card number__________________________  Expiry Date (Mo/Yr)  ____________

Name on card _________________________  Signature ____________________
 

Qty

FIVE Concert Package

FOUR*** Concert Package

Amount

(____) Adults @
 

(____) Students @

Prices in C$, including
GST and Box
Office Charge  

CDN $95.00
($85.00 until May 31/09)

CDN $47.50
($42.50 until May 31/09)

CDN $90.00
($80.00 until May 31/09)

CDN $45.00
($40.00 until May 31/09)

Tax Deductible Donation*

TOTAL

= $_________
 

= $_________
 

= $_________

= $_________

*** If you have chosen the FOUR Concert Package, please select your four concerts here:

(_) musica intima
(_) Shoshana Telner
(_) Penderecki String Quartet & Dancetheatre David Earle
(_) Quebec Viennese Music Society - The Infernal Waltz
(_) Gryphon Trio

(_) Check here if you do NOT want your donation to be acknowledged in concert programs

Reserved Seating Options

(_) I am renewing my subscription and wish to reserve the same seats (deadline April 30/09)

(_) I am indicating my preference below (list your preferred choices 1 to 3)

(_) Main Centre (Row C-K)
(_) Main Centre (Row L-S)
(_) Main Wings
(_) Balcony Centre
(_) Balcony Wings

Due to physical requirements, I will need the following:
(_) Wheelchair seating
(_) Aisle seating
(_) Seats close to the stage due to vision or hearing impairment
(_) Other _______________________________

* See "Sponsorship Plan" section.  Canadian Registered Charities Number: 11913 9376 RR
** As you would like to be listed in the concert programs if you are a sponsorship plan contributor

Business Number: 11913 9376 RT