• Name:
• Title:
• Organisation:
• Street Address:
• City:
• State / Province:
• Post / Zip Code:
• Country:
• Daytime Telephone Number:
• Email Address:
• Web Site Address:

Please provide some information about the plays
you would like to licence. We will need the
title of the play, the number of performances
for the play, the name and address of the venue
at which the play will be performed and the
intended dates of the performance

• Title of Play:
• Venue:
• No. of performances:
• Date of performances (Please specify each
  date)