childrensplaytimeproductions.com

EDUCATIONAL IMPACT THEATRE - WHERE EVERYBODY PLAYS

MAILING LIST INPUT FORM

P.O. Box 10087, Palm Desert, CA 92255-0087++ Phone: 760/841-3177 ++ Fax: 760/406-4027

Please use this form to be added to CPP's mailing list or to make corrections to your current contact information.

If you are under 18, please have your parent/guardian complete this form.

IF YOU ARE CORRECTING/CHANGING INFORMATION, PLEASE MAKE A NOTE OF THE OLD INFORMATION IN THE BOTTOM COMMENT BOX

Last Name for mailing list entry:

First name for mailing list entry:

Street Address (# and street or PO Box):

Alternate Phone Number:

COMPLETE E-Mail Address

(e.g., something@provider.com):

Please use this space if you have any questions or need to provide us with any relevant information:

I AM (check all that apply):

FILL OUT FORM AND HIT SUBMIT BELOW

City, State:

Zip Code:

Primary Phone Number:

This is a:

This is a:

Home PhoneCell PhoneWork Phone

Home PhoneCell PhoneWork Phone

A parent of a past/present CPP participant

A parent of a possible CPP participant

An adult actor and past/present CPP participant

An adult actor and possible CPP participant

Other (explain below)