Membership Form

Please check your desired membership level:

_____    Chorus Member: $25.00 - $49.00
_____    Supporting Actor: $50.00 - $99.00
_____    Lead Actor: $100.00 - $249.00
_____    Playwright: $250.00 - $499.00
_____    Director: $500.00 - $999.00
_____    Producer: $1000.00 or more   


Name/Business: _____________________________________________________________________________
Address: ___________________________________________________________________________________
City: _____________________________________________    State: __________________    Zip: ___________
Phone: ________________________________________    Email: _____________________________________
Shirt size: _____ S _____ M _____ L _____ XL _____ XXL

Payment Information:

_____ Cash        _____ Check/ #_____    


*Check out the "Become a Member" page for membership benefits.
**Please make checks payable to BREAKTHROUGH THEATRE.
***Print out this form and bring it to the Membership table in our lobby or mail to:

Breakthrough Theatre of Winter Park
c/o Wade Hair
3055 Riverbrook Drive
Winter Park, FL 32792