Ticket Request Form

REQUEST FOR FREE TICKETS

2009

How many tickets do you need? __________
If you need more than 6 tickets, please include a list of the names of the persons for whom you are requesting tickets below.

Because demand for tickets is expected to be high, please indicate your first and second choice for date/time:
Ticket requests are filled in the order they are received. We will do our best to give you your first choice.

_____ 1:00 pm Sat., Dec 5		_____ 1:00 pm Sun., Dec 6
_____ 4:00 pm Sat., Dec 5		_____ 4:00 pm Sun., Dec 6

PLEASE PRINT:

Name:	________________________________________________________
Address:	________________________________________________________
	________________________________________________________
Email:	________________________________________________________
Phone:	________________________________________________________

If you have any special needs, e.g. wheelchair access, please indicate here:

Your tickets will be mailed to you. Please include a self-addressed, stamped envelope.
Tickets will be distributed starting November 16.

Print, complete, and
mail this form
with SASE to:

     Christmas Lecture Tickets
     UW Chemistry Department
     1101 University Ave.
     Madison, WI 53706-1396

Because of the likelihood of very loud noises and the 75-minute length of the program,
we urge you not to bring children under 5 years of age.