THE COUNTER (Roundabout – The Laura Pels Theater), Saturday, October 19, 2:00pm

Contact & Ticket Order Info

First Name *

Middle Name

Last Name *

Address 1 *

Address 2

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Phone

# of Deaf Persons in Your Group *

This information is used for seating purposes.

Ticket Price

# of Deaf Tickets

$53.00
* a $3.00 per ticket convenience charge has been added to the price

# of Hearing Tickets

$53.00
* a $3.00 per ticket convenience charge has been added to the price

Total

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

Your Registration Info

Email Address *

159-00 Riverside Drive West
Suite 7F
New York, NY 10032

Voice: 212 740.3087
Fax: 212 740.4157
E-Mail: Info@HandsOn.org
Web Site: www.HandsOn.org