Richard Jay Simon Artistic Director		Ticket Form   To complete your order, call, mail, fax or email this form to us today.   SENIOR DISCOUNTS APPLY TO 65 YEARS OLD AND ABOVE.   Tickets will be released if not picked up five minutes before curtain.   1. Please complete the name and address section below Name Address City/State/Zip Telephone E-mail     2. Your purchase My order is for Select Show Amadeus Art Memory of Water Because He Can M Butterfly JAN Month FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Time 2:00 3:00 8:00 Adult Tickets ($27) Number of Tickets 1 2 3 4 5 6 7 8 9 10 Senior Tickets ($21) Number of Tickets 1 2 3 4 5 6 7 8 9 10 Student Tickets ($15) Number of Tickets 1 2 3 4 5 6 7 8 9 10 Total Amount Due 3. Your payment I am sending a check made payable to Mosaic Theatre      12200 West Broward Blvd., Plantation, FL 33325 Please bill my credit card Visa    Mastercard    Discover    Amex Name On Card Card Number Exp. Date JAN FEB Month MAR APR MAY JUN JUL AUG SEP OCT NOV DEC   Year 2004 2005 2006 2007 2008 2009 2010 How did you hear about the show?   MAIL TO MOSAIC THEATRE, 12200 West Broward Blvd., Plantation, FL 33325 PHONE (954) 57-STAGE (78243)        FAX (954) 473-4713
		American Heritage Center for the Arts, 12200 West Broward Boulevard, Building 3000 Plantation, Florida 33325,  phone: (954) 577-8243