Under 30 Club Entry Form

Personal Infomation

First Name*

Last Name*

Address*

City* State* Zip*

DOB* January February March April May June July August September October November December 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 Sex: MF

Email*

Phone* --

Thanks for joining LPT's Under 30 Club. On your next ticket purchase
remind the box office of your Under 30 Club, 1/2 price discount!