REGISTRATION FORM FOR CHIPOLA THEATRE SCHOLARSHIP AUDITIONS

Name

S.S.# Age  

Telephone    Cell Phone

Address

City State Zip

E-Mail Address

Check appropriate category High School Senior College Transfer

Name of School

I will audition on  February 26, 2009  March 24, 2009 April 23, 2009

SAT score ACT score

I wish to be considered in the following area(s)

Performance Production Both

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