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1 Please indicate your fees and method of payment. Note: PO and credit card payments will be adjusted to reflect correct fees as needed unless we are instructed NOT to do so below. If adjustments are NOT authorized, processing will be delayed until complete payment is received. Student members________at $22.00 each = $________ Please list students beginning on next page and complete the last page of this form. Optional rush service fee ($45.00 additional) = $ NOTE: Box above MUST be checked Total amount enclosed = $ Student certificates needed by* *This is NOT a guaranteed delivery date. Check or money order enclosed (please submit only one check or money order per school) School purchase order document enclosed. (P.O. number and administrator’s signature required.) INITIAL Do NOT adjust P.O. amount. Charge my: Visa MasterCard Diners Club American Express Fees are in effect August 1, 2010 - July 31, 2011. Fees are non-refundable. Membership is subject to the EdTA code of regulations and policies. Please send ALL materials under same cover to: The International Thespian Society P.O. Box 632347 Cincinnati, OH 45263-2347 Phone: 513-421-3900 Fax: 513-421-7055 www.schooltheatre.org Account Number Expiration Date Type or print legibly in black ink only. Troupe Number Troupe director: Prefix First Middle I. Last Suffix School Name Preferred School Address City St./Prov Zip or postal code Country School Phone Ext. School Fax Other Phone Check here for RUSH SERVICE $45 additional charge – include payment below FAXED forms (PO/ credit card), 5-business-day delivery. MAILED-IN forms (all), 10-business-day delivery. NOTE: Errors on form will cause delays. 2010-2011 High School Thespian Induction Roster Office use only Roster Completed_______________ _____ Cert. Sent _______________ _____ Processed _______________ Preferred troupe e-mail (monitored regularly by troupe director)* *used for e-mail bulletins, processing questions, order confirmations, etc. PLEASE DO NOT CONFIRM FAX ORDERS BY MAIL. Troupe director: Please make a copy of this report for your records prior to mailing. INITIAL Do NOT adjust credit card amount. CID/Card code (required): Amex = 4-digit # above account # on front of card, all others = last 3 digits in signature field on back of credit card: Credit card billing address Signature
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1
Please indicate your fees and method of payment. Note: PO and credit card payments will be adjusted to reflect correct fees as needed unless we are instructed NOT to do so below. If adjustments are NOT authorized, processing will be delayed until complete payment is received.
Studentmembers________at$22.00each = $________ Please list students beginning on next page and complete the last page of this form.
Optionalrushservicefee($45.00additional) = $ NOTE: Box above MUST be checked
Total amount enclosed = $
Studentcertificatesneededby* *This is NOT a guaranteed delivery date.
Checkormoneyorderenclosed(pleasesubmitonlyonecheckormoneyorderperschool)
Schoolpurchaseorderdocumentenclosed.(P.O.numberandadministrator’ssignaturerequired.) initial
DonOtadjustP.O.amount. Chargemy: Visa MasterCard DinersClub AmericanExpress
FeesareineffectAugust1,2010-July31,2011.Feesarenon-refundable.MembershipissubjecttotheEdtAcodeofregulationsandpolicies.Please send ALL materials under same cover to: The International Thespian Society P.O. Box 632347 Cincinnati, OH 45263-2347 Phone: 513-421-3900 Fax: 513-421-7055 www.schooltheatre.org
Accountnumber ExpirationDate
Type or print legibly in black ink only.
troupenumber
troupedirector:Prefix First MiddleI. Last Suffix
Schoolname
PreferredSchoolAddress
City St./Prov Ziporpostalcode
Country
SchoolPhone Ext. SchoolFax
OtherPhone
Check here for RUSH SERVICE $45 additional charge – include payment below
FAXEDforms(PO/creditcard),5-business-daydelivery.MAILED-Informs(all),10-business-daydelivery.nOtE:Errorsonformwillcausedelays.
2010-2011 High School Thespian Induction Roster
Office use only
RosterCompleted_______________
_____Cert.Sent_______________
_____Processed_______________
Preferredtroupee-mail(monitoredregularlybytroupedirector)**usedfore-mailbulletins,processingquestions,orderconfirmations,etc.
PLEASE dO NOT CONFIRm FAx ORdERS By mAIL.
Troupe director: Please make a copy of this report for your records prior to mailing.
initial DonOtadjustcreditcardamount.
CID/Cardcode(required):Amex=4-digit#aboveaccount#onfrontofcard,allothers=last3digitsinsignaturefieldonbackofcreditcard:
Creditcardbillingaddress
Signature
EdTA Membership Dept.
IMPORTANT NOTE: Using interactive PDF forms
- To fill out and save a copy of your roster form on your computer, you must have Adobe Acrobat Reader 8 or higher (get.adobe.com/reader). - Click "File/Save as" to save the blank PDF form to your computer before filling in the fields. - Be sure to save your completed form when finished. - Click out of any data field before printing. Any field the cursor is occupying will not print. - To submit, the troupe director must print the form and mail or fax it as requested on on the form. All forms must be authorized with an official troupe director signature. - If you have problems using this PDF feature, print the form and type or print legibly in black ink.
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1.name:First MiddleI. Last Suffix
Male Female Homeaddress
City St./Pr. Zipcodeorpostalcode
E-mail Idonotwishtoreceivescholarship,college,orotherinformationbymail.
Grade: 9 10 11 12 Graduationyear Officeuseonly
2.name:First MiddleI. Last Suffix
Male Female Homeaddress
City St./Pr. Zipcodeorpostalcode
E-mail Idonotwishtoreceivescholarship,college,orotherinformationbymail.
Grade: 9 10 11 12 Graduationyear Officeuseonly
3.name:First MiddleI. Last Suffix
Male Female Homeaddress
City St./Pr. Zipcodeorpostalcode
E-mail Idonotwishtoreceivescholarship,college,orotherinformationbymail.
Grade: 9 10 11 12 Graduationyear Officeuseonly
4.name:First MiddleI. Last Suffix
Male Female Homeaddress
City St./Pr. Zipcodeorpostalcode
E-mail Idonotwishtoreceivescholarship,college,orotherinformationbymail.
Grade: 9 10 11 12 Graduationyear Officeuseonly
Pleaseobtaincurrentaddressinformationfromeachstudent.Donotcopyfromschoolrecords.MAILPOLICY:EdtA/ItSmaysharethespianmailinginformationwithcolleges,universities,orotherorganizationsthatmightbeofinteresttomembers.tooptoutofreceivingmail,checktheappropriateboxforeachthespian.E-MAILPOLICY:Providinge-mailaddressesisoptionalandauthorizesEdtA/ItStosende-mailcorrespondencetomembers.EdtA/ItSdoesnotreleasethespiane-mailaddressestothird-partyvendorsbutmaydelivercarefullyscreenedoffersandinformationonbehalfofselectedschoolsandorganizations.Membersmayoptoutofe-mailcorrespondenceatanytime.
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5.name:First MiddleI. Last Suffix
Male Female Homeaddress
City St./Pr. Zipcodeorpostalcode
E-mail Idonotwishtoreceivescholarship,college,orotherinformationbymail.
Grade: 9 10 11 12 Graduationyear Officeuseonly
6.name:First MiddleI. Last Suffix
Male Female Homeaddress
City St./Pr. Zipcodeorpostalcode
E-mail Idonotwishtoreceivescholarship,college,orotherinformationbymail.
Grade: 9 10 11 12 Graduationyear Officeuseonly
7.name:First MiddleI. Last Suffix
Male Female Homeaddress
City St./Pr. Zipcodeorpostalcode
E-mail Idonotwishtoreceivescholarship,college,orotherinformationbymail.
Grade: 9 10 11 12 Graduationyear Officeuseonly
8.name:First MiddleI. Last Suffix
Male Female Homeaddress
City St./Pr. Zipcodeorpostalcode
E-mail Idonotwishtoreceivescholarship,college,orotherinformationbymail.
Grade: 9 10 11 12 Graduationyear Officeuseonly
9.name:First MiddleI. Last Suffix
Male Female Homeaddress
City St./Pr. Zipcodeorpostalcode
E-mail Idonotwishtoreceivescholarship,college,orotherinformationbymail.
Grade: 9 10 11 12 Graduationyear Officeuseonly
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Pleaseallow3weeksfromthedateofreceiptforustoprocessyournon-rushinductionrosterform.
Certificatesandmembershipcardsforallnewmemberslistedwillbemailedtothetroupedirectoroncethisformandallmembershipfeesarere-ceivedatthehomeoffice.Dramaticssubscriptionswillbegin6-8weeksafterprocessingforstudentsinductedAugust–March.StudentsinductedApril–JulywillreceivetheirfirstissuesinSeptember.
I hereby certify that the students named above have fulfilled all requirements and are worthy of membership in the Interna-tional Thespian Society. I have informed these students that $13.51 of each basic membership fee is payment for a one-year subscription to Dramatics magazine.
Signatureoftroupedirector Date
Student membership Benefits •One-yearsubscriptiontoDramatics (9issues), renewableatadiscountedrate •Membershipcard •Membershipcertificate •Eligibilityforthespianscholarshipprogramsandotherbenefitsthroughouthighschool;namepermanentlykeptonmembershiprollsatthehomeoffice. •Aportionofeachstudent'sfeehelpsfundthespianscholarshipprograms.
10.name:First MiddleI. Last Suffix
Male Female Homeaddress
City St./Pr. Zipcodeorpostalcode
E-mail Idonotwishtoreceivescholarship,college,orotherinformationbymail.
Grade: 9 10 11 12 Graduationyear Officeuseonly
11.name:First MiddleI. Last Suffix
Male Female Homeaddress
City St./Pr. Zipcodeorpostalcode
E-mail Idonotwishtoreceivescholarship,college,orotherinformationbymail.
Grade: 9 10 11 12 Graduationyear Officeuseonly
12.name:First MiddleI. Last Suffix
Male Female Homeaddress
City St./Pr. Zipcodeorpostalcode
E-mail Idonotwishtoreceivescholarship,college,orotherinformationbymail.
Grade: 9 10 11 12 Graduationyear Officeuseonly
Find all the forms and information you need at our website, www.schooltheatre.org
