9070 Venice Blvd. Culver City, CA 90232

www.theactorsgang.com

(310) 838-4264 ext. #15

 

2008/2009 Flex Pass Order Form

Please Complete The Following

 

First:                                    Last:

Address:                                                        Apt.

City:                                     State:                Zip:

Home Phone:                          Alt:

Email:

Special Instruction:

 

Please Check One of the Following           

- $ 75.00 Four Ticket Flex Pass

- $100.00 Six Ticket Flex Pass

- $125.00 Eight Ticket Flex Pass

- $150.00 Ten Ticket Flex Pass

- Donation $________________

 

If you wish to have your flex vouchers mailed to you please add an additional $5.00 and we will send them to you!

- $5.00 Yes, Mail My Vouchers

PAYMENT

Circle One of the Following: Check Visa Mastercard AMEX

C.C.#                                                         exp.

Amount to be Charged: $

 

Please Sign Here_______________________________________

Thank you For Supporting The Actors’ Gang