Video Request Form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" height=82 BGCOLOR="#CCCC99" TEXT="#080000" bgproperties="fixed" background="0ff8dfe1esnpes.jpg"> <div> <FONT SIZE="5" COLOR="#000000" FACE="Arial" ><B>Bedford Dance Center</B></FONT><B>     </B><B>|</B><B>     </B><A HREF="index.htm" TARGET="_top" TITLE="Bedford Dance Center"><U><B>home</B></U></A></div> <div> <A HREF="id55.htm" TARGET="_top" TITLE="TShirt/Sweatshirt Order Form"><U>T-Shirt/Sweatshirt Order Form</U></A>   |   <A HREF="id43.htm" TARGET="_top" TITLE="Ticket Request Form"><U>Ticket Request Form</U></A>   |   <A HREF="id28.htm" TARGET="_top" TITLE="Registration Form"><U>Registration Form</U></A>   |   <B>Video Request Form</B>   |   <A HREF="id54.htm" TARGET="_top" TITLE="Playbill Ad Form:"><U>Playbill Ad Form:</U></A>   |   <A HREF="id58.htm" TARGET="_top" TITLE="Spring Workshop Registration"><U>Spring Workshop Registration</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" height=398 BGCOLOR="#CCCC99" TEXT="#080000" bgproperties="fixed" background="0ff8dfc3.jpg"> <div> <I>Video Request Form</I></div> <bR> <div> <B><U>FESTIVAL OF DANCE ~ DVD ORDER FORM</U></B></div> <bR> <div> <B>Cost:  $33/each </B><B>(DVD will be mailed directly to you.)</B></div> <bR> <div> <B>Return to:  Bedford Dance Center, 1</B><B>72 Route 101, Bedford, NH, 03110</B></div> <bR> <bR> <bR> <bR> <div> <B>NAME:_______________________________________________________________________________</B></div> <bR> <bR> <div> <B>ADDRESS:___________________________________________________________________________</B></div> <bR> <div> <B>                      __________________________________________________________________________</B></div> <bR> <bR> <div> <B>PHONE:_______________________              E-Mail:_________________________________________</B></div> <bR> <div> _____ 1:00 Performance                _____ 6:00 Performance</div> <bR> <div> <B>TOTAL VIDEOS ORDERED________</B></div> <bR> <div> <B>AMOUNT ENCLOSED $___________</B></div> <div>        </div> <bR> <bR> <bR> <DIV ALIGN="LEFT"></DIV> <div> (Checks should be made payable to Bedford Dance Center)</div> <bR> </td> </tr></table></body>