Your name: * Address: City, State: * Zip Code: E-mail Address: * Telephone: * Alternate Telephone (i.e. Cell) ............................................................................................ When are you planning to have the party? (mm/dd/yyyy) Approx. what time would you like the magic show to begin? Name of person(s) having a birthday: How old will the birthday person(s) be? What is the address where the party be held? Approx. how many children will be at the party? 1 - 5 5 -10 10 - 15 15 - 20 20 - 25 25 - 30 30 - 40 40 - 50 50 - 70 more than 70 I'm not sure yet Is there a theme for the party? (i.e. Princess theme, Harry Potter theme, etc.) Yes No Have not decided on one yet If yes to the previous question, what is the party theme? Approx. how many adults will attend the party? 1 - 5 5 -10 10 - 15 15 - 20 20 - 25 25 - 30 30 - 40 40 - 50 50 - 70 more than 70 I'm not sure yet The party will be held at: Private residence Public restaurant Community building Hotel Public Park - Outdoors other What are you interested in? The Basic Show The Deluxe Show Balloon Sculpture Upgrade How would you prefer to be contacted with a birthday party show quote? Contact me by phone Contact me by e-mail Contact me by snail mail How did you hear about Comedy Magician Lyndel? Internet search Linked to him from another web site Saw him perform live A friend told me about him I saw an ad for his services His name came to me in a dream Anything else you would like for us to know? Please enter the security word in the box to the right before hitting submit. Thank you!