Please Print this form, and mail it to:

Ars Antiqua
26 North Greeley Ave.
Chappaqua, New York 10514

Quantity			Subtotal
_______	Benefactor (First Priority Seating)..........	$500.00	$_____________
_______	Donor (Second Priority Seating)................	$250.00	$_____________
_______	Patron (Special Reserved Seats)....................	$175.00	$_____________
_______	Sponsor (General Admisson)........................	$150.00	$_____________
_______	Single Ticket Subscription (General Admisson)...	$75.00	$_____________
		Total:	$_____________

Name:___________________________________________________________

Address:_________________________________________________________

City:_______________________________State__________Zip_____________

Phone:________________________________

Email:___________________________________________________________

Please make checks payable to: Ars Antiqua

Mail to the Ars Antiqua administrative office at:
26 North Greeley Avenue
Chappaqua, New York 10514

For information and ticket availability call (914) 238-8015