Broadway Theatre of Pitman

BROADWAY THEATRE OF PITMAN

BROADWAY SCHOOL OF LAUGHS COMEDY SCHOOL

MARCH 17 – APRIL 21, 2010

Please complete a separate application for each registrant

Name ______

Street Address ______

City/State/Zip ______

Home Phone ______Alternate Phone # ______

E-mail Address ______

The Comedy School runs on Wednesday nights from 7PM-9PM from March 17th thru April 21st. The Comedy Show performance will be on Thursday, April 22nd at 8PM. Each registrant will be allowed 2 complimentary tickets to the performance. Additional tickets may be purchased for $15.

In consideration of participating in this program, on behalf of myself, my heirs, personal representatives, and all those claiming by or through me consent to, and so hereby discharge and release and forever hold harmless Preserve Pitman Investment Group, LLC dba Broadway Theatre of Pitman and their affiliates, sponsors, agents, servants, employees, assigns, successors, and heirs and any facility at which events are held, from any and all claims, actions, losses, damages, or expenses for personal or bodily injury (including death), and property lost or damage of whatever nature or cause, incurred by me or arising out of or in conjunction with my participation in the aforementioned event. I hereby consent that I am of legal age and have read and understand the contents of this consent and release.

Signature of Registrant ______

Pictures will be taken during the camp. I give Broadway Theatre of Pitman permission to include my picture(s) and for them to be used by the Broadway Theatre of Pitman at their discretion.  Yes  No

Registration:

Registration begins Monday, January 25, 2010. Please be advised that registration is on a first-come, first-served basis. Early registration is strongly encouraged since space is limited and will fill up quickly. Payment for Comedy School is completely non-refundable for any reason whatsoever.

Payment/Authorization:

Fee: $400.00______

Payment Due Date:with applicationSignature of Registrant Date

Please charge the $400.00 fee to:  Visa MasterCard American Express

Credit Card Number ______Exp. Date: ______3/4 digit Security Code: ______

Check Enclosed: Check # ______

Return this completed application along with payment to the Broadway Theatre of Pitman, PO Box 118, Pitman, NJ 08071. If you have any questions, please contact Customer Service at 856.384.8381 Monday through Friday, 8 AM to 4 PM. The physical address of the theatre (but not the mailing address) is 43 South Broadway, Pitman, NJ 08071. Submit your application early to ensure availability. You may also fax your completed form to (856) 848-6091.