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Name of Season Pass Holder:  (Please Print or Type)

_________________________________________________________________________
Last                                                                   First                                                       MI

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Address                                                           City                               State                   Zip

_________________________________________________________________________
Phone Number                                                 Email
Please include your email address if you would like reminders of ticket reservation weeks and show information.

If you are a Producer, Principal, Player, or Patron, please print your name or business clearly as it should appear on the playbill:

_________________________________________________________________________

Little Theatre offers the convenience of charging your subscription on your VISA or Mastercard. 
Please indicate your method of payment:

__ Check Enclosed       __ VISA      __ Mastercard

Credit Card #______________________________________  Exp.___________________ 

Name as appears on card____________________________________________________

________________________________________________________________________ Signature

Mail this form along with payment or charge information to:
HALIFAX COUNTY LITTLE THEATRE
PO Box 23, South Boston, Virginia 24592
Any questions?  Call 434-575-7473 or visit our website at www.hclt.org