Name: * Address: City: * State: * Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming Outside of USA Zip Code: Phone: * E-Mail Address: * What is the name of the school you represent? What date would you like the school assembly to be held on? (mm/dd/yyyy) Which of Lyndel's shows are you interested in? The Anti-Drug Show The Reading Show The Character Development Show Lyndel's Fun Show Not sure How many assemblies will you need to accommodate all of the students that you want to see the show? One Assembly Two Assemblies Three Assemblies Four Assemblies Five Assemblies Not sure... Are you interested in: Day time show(s) Evening show(s) Day time show(s) and an evening show The purpose of the show is: Student Motivation PTA/PTO Family Night Student Motivation & Family Night Fundraiser Fall Festival Mid Year Party End Of Year Party Reward Show After School Program Has your school booked with Lyndel Productions in the past? Yes No I don't know How did you hear about Lyndel Productions? Worked with Lyndel Productions in the past A friend referred me to Lyndel Productions I received a mailing from Lyndel Productions Saw Lyndel perform at another school / event At a PTA/PTO Showcase Please type the security word you see in the box before hitting submit. Thanks!