Heartless Trip Form Fall 2012 (PDF)

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The Lee Strasberg Theatre & Film Institute
NYU Upperclassmen & TYPAC Trip to Heartless
Fall 2012 Ticket Reservation Form
Name:_________________________________________ Which program are you enrolled in?___________________
Address: _______________________________________ City:_________________ State: ______Zip: ___________
Cell Phone #: ________________________ Email Address:________________________________________

Student Ticket to Heartless at 2:00pm on Sunday September 30th, 2012
 Price per student ticket: $25.00


Your $25 non-refundable ticket price is required to attend Heartless at 2:00pm on Sunday, September 30th,
2012. Full payment for ticket is due September 21st, 2012.
 I have enclosed a money order (personal check) payable to The Lee Strasberg Theatre & Film Institute.
 I have enclosed in cash.
 Please charge $25.00 to my credit card. I understand that this card will be charged with full ticket price on or before
September 21st, 2012.
Acct. Number_____________________________________________________
Expiration Date ______/______

Security Code (4-digit AmEx; 3-digit Visa/MC/Discover) :__________

Signature _________________________________________________________
The contract below constitutes the Lee Strasberg Theatre & Film Institute Ticket Purchase Agreement.
Your signature below indicates you have read this form.

will attend Heartless at Pershing Square, Signature Center, The Irene
Diamond Stage, 480 W 42 St, New York, NY 10036 on Sunday, September 30th, 2012 at 2:00PM. Ticket price must be
paid by September 21st, 2012. Ticket price may be paid by money order (personal check), cash, or credit card (Visa,
American Express, MasterCard, or Discover).

We will meet outside the theatre complex between 1:30PM-1:50PM.
Once there, you will receive your ticket from the Student Liaisons, Victoria Ng & Jasmine Pierce.
If you are running late, please text or call one of them at 732-331-3222 or 513-382-9552
There is NO REFUND of the ticket price.
Payment cannot be refunded after the performance.
The student, who is hereby agreeing to payment and will thereby be attending this event, must sign this agreement.



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