Request edit access
Save Me A Seat
Sign in to Google to save your progress. Learn more
Email *
Your name *
Address *
City, State, Zip Code *
Phone number *
Inscription-2 lines maximum, up to 20 characters per line, including spaces.   *
I/we understand that I must call 605-255-4910 to make the $500.00 contribution per seat and that the plaque(s) will not be ordered until I have done so.  I further understand that, if I haven't made my contribution, the Playhouse will reach out to me. *
Required
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Theatre 605 / Black Hills Playhouse, Inc..

Does this form look suspicious? Report