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1. Customer Information

 
 50% of survey complete.

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* 1. Please confirm the date and time that you will attend the reading of Ken Urban's A GUIDE FOR THE HOMESICK.

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* 2. Please confirm the location of the reading:

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* 3. Please indicate the number of seats you would like to reserve:

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* 4. First Name

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* 5. Last Name

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* 6. E-Mail Address (Your contact info will be used only in the event of a rescheduling or cancellation)

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* 7. Phone

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* 8. Affiliation

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