SOUVENIR VIDEO & PHOTO ORDER FORM

GREAT RUSSIAN NUTCRACKER 2002      MOSCOW BALLET

VIDEO—$40.00                  PHOTO—$25                VIDEO & PHOTO COMBO—$60

    Quantity                                          Total

Name:___________________________________         ______ VIDEOS @ $40     =    $_______

Address:_________________________________         ______ PHOTOS @ $25    =    $_______

City:_________________ State:____ Zip:_______         ______ COMBO @ $60     =    $_______

Phone: day___________ eve________________           Total Amount Enclosed              $_______

E-mail:_______________________________________

Date & Time of Performance: December 1^st, 2002

Performance City & Theatre: Jackson, Mississippi at Thalia Mara Hall

Hurry! Payment must be received by: October 27^th, 2002

Payment by (check one):

□ Visa            □ Mastercard             □ American Express            □ Discover               □ Check

                                                                            Please make checks payable to: Nut 2002, Inc.

Card Holder Name_______________________________________________________

Card #___________________________________ Expiration_____________________

Signature________________________________________ Date__________________

Submit order form & payment to: Ms. Debra Franco, Debra Franco Preparatory School of Dance

3420 Wisconsin Avenue, Suite 2, Vicksburg, Mississippi 39180