Print this form and mail to:  

North Bay Symphony Orchestra, 2nd floor-150 Main St. East, North Bay, ON  P1B 1A8

or fax this form to:  705-495-8878 

Adult/Senior # _____ @ $105.00 = ____________

Youth (13-18) # _____ @ $ 42.00 = ____________

Child ( 4-12) # _____ @ $ 30.00 = ____________   

Name:_________________________________________

Address________________________________________

City:____________ Prov:_______ Postal Code__________

E-mail _____________________________________

Telephone:____________________________

Same seats as last year Yes _______ No ________

Preferred Seating: Row ____ Seat #’s _______________

Payment Method:

1.  Cheque enclosed  MUST BE PAYABLE TO "THE CAPITOL CENTRE"

2.  Credit Card #    ________________________________

     Exp. Date         ____/____

     Name on Card  ________________________________

NOTE:  The Capitol Centre Box Office fee of $4.50 for each ticket order will be applied