Close-Ups: Psychoanalysts
Look at Film
Name:__________________________________________________
Address:________________________________________________
Phone:_________________________________________________
E-mail
Address:_________________________________________
No. of series
tickets___________ x 4 =_________________ tickets
No. of
individual film tickets:
1)
4/11________ 2)
4/18________ 3) 4/25______ 4) 5/2_______
Student
at:________________________________________________
Amount
Enclosed:_______________________________________
Refunds will
be given for cancellations made no later than one week
prior to the
program.