MEMBERSHIP ENROLLMENT FORM 

Please print this form, complete, include payment, and mail to:

The Grand 1894 Opera House
2020 Postoffice Street
Galveston, Texas  77550

SELECT A ROLE
Extra ($25) Cameo Role ($250)
Walk On ($50) Co-Star ($500)
One Liner ($75) Producers Circle ($1,000)
Supporting Role ($150) Angel ($1,894 and above)
Check here if you would like to receive your membership benefits
I work for a company that matches employee contributions.
Name
Address
City/State/Zip
I would like my name
 listed as
(Print your name(s) as you would like listed in our programs
In Honor Of
In Memory Of
PAYMENT INFO
Check or Money order   Visa/MC   American Express   Discover
Credit Card No.
Expiration Date
Name as it appears on card
Address of cardholder
City/State/Zip
Daytime Phone
Signature