Origin Theatrical

Application Form

Request for Information and Royalty/Hire Fees
Name of Musical / Play:
Information about your School/Organisation
School/Organisation:
Contact Name:
Address:
State / Postcode:	NSWQLDVICSAWANTACTTASNZOverseas
Phone Contact/s Please include area/country codes:	home: work: fax:
E-Mail Address:
Information about your production
Name of Theatre:
Address:
Capacity:
Ticket Price/s:
Performance Date(s):
Number of Performances:
Perusal Copies: Cost is A$24.00 (plus gst for Australian residents) for each perusal package ordered. You may order up to 3 musicals and keep the material for 4 weeks unless notified otherwise. Payment must be received prior to perusal materials being dispatched.
Perusal Items Requested
	Musical   ABCDEFGHIJKLMNOPQRSTUVWXYZ
No Perusals Selected.
Bank Details: ORiGiN Theatrical Pty Ltd National Australia Bank, 255 George Street , Sydney BSB: 082 057 Account No: 57 674 7182
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