| Fill in the following to receive your complimentary Broadway Junior CertifiKIT:
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The following information should be filled out by the director of your production. This information will NOT be printed in your press release. Your CertifiKIT will be sent to this address.
Please submit your application only once. Multiple submissions will only delay the processing of your CertifiKIT. Please note that applications placed less than four weeks prior to your production cannot be guaranteed to arrive by your opening date.
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| *School/Organization Name |
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*Account Number
(located on your Broadway Junior Contract) |
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*Country
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| *Zip Code |
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| *Street Address |
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| *City |
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| County |
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| *State |
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| *Name |
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| *Contact Phone |
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| *Contact E-mail |
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| Age range of students participating |
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| Grade range of students participating |
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| How many students are in the cast? |
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| How many students are on the crew? |
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| The following information, as entered by you, WILL be printed in your press release. Please double check your entry data for typos, dates, etc.
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| *Performance Venue |
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| If address is the same as above, check here |
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| *Country |
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| *Zip Code |
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| *Street Address |
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| *City |
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| County |
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| *State |
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| *Name of Show |
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| *Number of Performances |
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*Opening Date (mm/dd/yyyy)
i.e. 06/19/2004 |
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| Please give us the names of some of your local media. |
| *Local Newspaper 1 |
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| Local Newspaper 2 |
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| Local Newspaper 3 |
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*Ticket Contact Phone Number
(Box Office/Administrative Office) |
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| Theatre or organization website address |
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By submitting this form, you hereby certify that you are the authorized
agent for this production and that the information submitted is correct.
You and/or your organization will be held responsible for any invalid or
falsified information.
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