Chance-a-thon Deposit Form

Thank you for signing up to be part of the Chance-a-thon!!
We’re thrilled you will be presenting an act!!

As the Chance-a-thon is a major fundraising event for our company, in order to provide you with your time slot, we ask you to please include a deposit to secure your stage time. This deposit will be fully refunded to you after the event once you have made your minimum pledge goal.

Use the secure form below or call Erika Miller at (657) 549-0499 to provide your payment info or for further questions.

Please enable JavaScript in your browser to complete this form.

Name *

First

Last

Email *

Phone *

All acts are required to leave a fully-refundable deposit in order to secure their time slot. *

• 30 - 40 min - Fyda-Mar Stage Deposit - $50.00
• 30 - 40 min - Cripe Stage Deposit - $75.00
• 60 - 80 min - Fyda-Mar Stage Deposit - $75.00
• 60 - 80 min - Cripe Stage Deposit - $150.00

Please note: Due to the limited number of time slots available, if you cancel your participation in the Chance-a-thon after July 10 then you will lose your deposit. (The deposit will be counted as a donation to the theater and will be fully tax deductible.)

Total

$0.00

Stripe Credit Card *

Card

Name on Card

Transactions secured with 256-bit SSL encryption.

Billing Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Comments / Questions

Email

Submit