Name

Address

City, State, Zip

Phone

Email

How many trivia night reservations?

8 Seats = 1 Table
I want to purchase individual seats at $25 each	I want to purchase a table(s) at $175 per table
How many INDIVIDUAL SEATS:	How many TABLES:

PAYMENT INFORMATION:
Once this form has been submitted you will be contacted by a St. Louis Ballet School representative in which you will be able to pay by Visa/MC/Discover or check. Your reservation is not confirmed until payment is received.

AGREEMENT:
I understand that all reservations are non-refundable and I will be contacted by a representative of SLBS for payment information.