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Please fill in the information below to sign up for the Mr. History Musical in your area.

Show: Glory Road!
Available dates: February 2-5, 2009
Available times: 10:00 a.m. and 12:00 p.m.

(Note: All fields are required)

School:

Grade:

Address:

City:

State:

Zip:

Contact Name:

Contact E-mail:

Contact Phone:

# of Tickets: Total Cost @ $10 each:

Desired date:

Desired time:

Comments:

Please make checks payable to:

Quill Entertainment Company, 983 North Street, Greenwich, CT 06831

You may contact us at 203.253.2232