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It is our hope that your group, limited to one (1) chaperone for each five (5) attendees, will attend as our guests. If more chaperones are desired, there will be a charge of $4.00 per person. This FEE IS TO ACCOMPANY THE APPLICATION. Please complete this form and return it to the Irem Shrine Circus Office, 22 East Union Street, Kingston, PA 18704. Deadline for this information is March 25th, 2012. Handicapped will receive special consideration, however, we must limit wheelchairs to four (4) per show per group. Please list total attending and alternate performance dates. Your strict attention to seats requested and circus attendance will be greatly appreciated. Allan Rose (Guest Chairman). Phone (570) 654-3936. |
| Group Name | Group Leader |
| Address | Phone |
| Remarks | PREFERRED SEATING: MAIN FLOOR BALCONY |
| SPECIAL INSTRUCTIONS OR REQUESTS: |
| Monday Afternoon (4/9) | 1:30 P.M. | # of Children | # of Adults | |||||
| # of Wheelchairs | # of Buses | # of Vans | ||||||
| Monday Evening (4/9) | 7:00 P.M. | # of Children | # of Adults | |||||
| # of Wheelchairs | # of Buses | # of Vans | ||||||
| Tuesday Evening (4/10) | 6:30 P.M. | # of Children | # of Adults | |||||
| # of Wheelchairs | # of Buses | # of Vans | ||||||
| Wednesday Morning* (4/11) | 10:00 A.M. | # of Children | # of Adults | |||||
| # of Wheelchairs | # of Buses | # of Vans | ||||||
| Thursday Morning* (4/12) | 10:00 A.M. | # of Children | # of Adults | |||||
| # of Wheelchairs | # of Buses | # of Vans | ||||||
| Friday Morning* (4/13) | 10:00 A.M. | # of Children | # of Adults | |||||
| # of Wheelchairs | # of Buses | # of Vans | ||||||
| Saturday Matinee (4/14) | 1:30 P.M. | # of Children | # of Adults | |||||
| # of Wheelchairs | # of Buses | # of Vans |
| Phone (570) 714-0783 |