<h2>Ticket Order Form</h2><p>You can now reserve your tickets ONLINE in three easy steps. If you have any questions, e-mail <a href="mailto:gandree@siue.edu">gandree@siue.edu</a> or contact the Fine Arts Box Office in Dunham Hall at (618) 650-5774.</p><p><strong>Step 1:</strong> &nbsp; Select the ticket(s) you would like to reserve below. Click the &ldquo;Calculate&rdquo; button to confirm the total. <strong>Note: a $2 service and handling fee applies to credit card orders.</strong></p><form name="mail" action="http://www.siue.edu/cgi-bin/FormMail.pl" method="post"><input name="recipient" type="hidden" value="gandree@siue.edu" /><input name="required" type="hidden" value="email" /><input name="redirect" type="hidden" value="http://www.siue.edu/artsandissues/thanks.shtml" /><input name="subject" type="hidden" value="Arts and Issues Series Ticket Order" /> <table border="0" width="95%" cellspacing="0" cellpadding="2"> <tr> <td width="263"></td> <td width="94" bgcolor="#000000"> <div align="center"><span style="color:#FFFFFF;"><strong># of sub-<br /> scriptions</strong></span></div> </td> <td width="1" bgcolor="#000000"></td> <td width="138" bgcolor="#000000"> <div align="center"><span style="color:#FFFFFF;"><strong>SIUE Staff, Retirees, and Alumni</strong></span> <p><span style="color:#FFFFFF;"><strong>Seniors 65 or older</strong></span></p> </div> </td> <td width="124" bgcolor="#000000"> <div align="center"><span style="color:#FFFFFF;"><strong>General Single</strong></span></div> </td> <td bgcolor="#000000" width="71"> <div align="center"><span style="color:#FFFFFF;"><strong>Students</strong></span></div> </td> <td bgcolor="#000000" width="10"></td> <td width="39" bgcolor="#000000"> <div align="center"><span style="color:#FFFFFF;"><strong>Total</strong></span></div> </td> </tr> <tr> <td></td> <td bgcolor="#000000"> <div align="center"><span style="color:#FFFFFF;"><strong>all 8 shows</strong></span></div> </td> <td bgcolor="#000000"></td> <td bgcolor="#000000"> <div align="center"><span style="color:#FFFFFF;"><strong>Ticket</strong></span></div> </td> <td bgcolor="#000000"> <div align="center"><span style="color:#FFFFFF;"><strong>Ticket</strong></span></div> </td> <td width="71"></td> <td width="10"></td> <td></td> </tr> <tr> <td bgcolor="#cccccc"><strong>Three Dog Night<br /></strong> October 8, 2011</td> <td bgcolor="#cccccc"></td> <td bgcolor="#cccccc"></td> <td bgcolor="#cccccc"> <div align="center"><input name="number_of_alumni_Zhang_tickets" size="2" type="text" value="" id="number_of_alumni_Zhang_tickets" /><label for="number_of_alumni_Zhang_tickets">x</label> $20</div> </td> <td bgcolor="#cccccc"> <div align="center"><input name="number_of_general_Zhang_tickets" size="2" type="text" value="" id="number_of_general_Zhang_tickets" /><label for="number_of_general_Zhang_tickets">x</label> $25</div> </td> <td bgcolor="#cccccc" width="71"> <div align="center"><input name="number_of_student_Zhang_tickets" size="2" type="text" value="" id="number_of_student_Zhang_tickets" /><label for="number_of_student_Zhang_tickets">x</label> $13</div> </td> <td bgcolor="#cccccc" width="10"> <div align="center">=</div> </td> <td bgcolor="#cccccc">$<input name="Zhang_total_cost" size="4" type="text" value="" id="Zhang_total_cost" /></td> </tr> <tr> <td><strong>Zucchero<br /></strong> October 20, 2011</td> <td></td> <td bgcolor="#ffffff"></td> <td bgcolor="#ffffff"> <div align="center"> <div align="center"><input name="number_of_alumni_Winston_tickets" size="2" type="text" value="" id="number_of_alumni_Winston_tickets" /><label for="number_of_alumni_Winston_tickets">x</label> $20</div> </div> </td> <td bgcolor="#ffffff"> <div align="center"><input name="number_of_general_Winston_tickets" size="2" type="text" value="" id="number_of_general_Winston_tickets" /><label for="number_of_general_Winston_tickets">x</label> $20</div> </td> <td bgcolor="#ffffff" width="71"> <div align="center"><input name="number_of_student_Winston_tickets" size="2" type="text" value="" id="number_of_student_Winston_tickets" /><label for="number_of_student_Winston_tickets">x</label> $13</div> </td> <td width="10"> <div align="center">=</div> </td> <td>$<input name="Winston_total_cost" size="4" type="text" value="" id="Winston_total_cost" /></td> </tr> <tr> <td bgcolor="#cccccc"> <p><strong>Neil deGrasse Tyson<br /></strong> December 7, 2011<br /></p> </td> <td bgcolor="#cccccc">SOLD OUT</td> <td bgcolor="#cccccc"></td> <td bgcolor="#cccccc"> <div align="center"> <div align="center"><input name="number_of_alumni_Eisenhower_tickets" size="2" type="text" value="" id="number_of_alumni_Eisenhower_tickets" /><label for="number_of_alumni_Eisenhower_tickets">x</label> $15</div> </div> </td> <td bgcolor="#cccccc"> <div align="center"><input name="number_of_general_Eisenhower_tickets" size="2" type="text" value="" id="number_of_general_Eisenhower_tickets" /><label for="number_of_general_Eisenhower_tickets">x</label> $28</div> </td> <td bgcolor="#cccccc" width="71"> <div align="center"><input name="number_of_student_Eisenhower_tickets" size="2" type="text" value="" id="number_of_student_Eisenhower_tickets" /><label for="number_of_student_Eisenhower_tickets">x</label> $13</div> </td> <td bgcolor="#cccccc" width="10"> <div align="center">=</div> </td> <td bgcolor="#cccccc">$<input name="Eisenhower_total_cost" size="4" type="text" value="" id="Eisenhower_total_cost" /></td> </tr> <tr> <td> <p><strong>Green Fire &amp; Curt Meine<br /> </strong>February 2, 2012<br /></p> </td> <td></td> <td bgcolor="#ffffff"></td> <td bgcolor="#ffffff"> <div align="center"> <div align="center"><span style="text-decoration:line-through"><input name="number_of_alumni_Greenfire_tickets" size="2" type="text" value="" id="number_of_alumni_Greenfire_tickets" /></span><label for="number_of_alumni_Greenfire_tickets">x</label> $10</div> </div> </td> <td bgcolor="#ffffff"> <div align="center"><span style="text-decoration:line-through"><input name="number_of_general_Greenfire_tickets" size="2" type="text" value="" id="number_of_general_Greenfire_tickets" /></span><label for="number_of_general_Greenfire_tickets">x</label> $15</div> </td> <td bgcolor="#ffffff" width="71"> <div align="center"><span style="text-decoration:line-through"><input name="number_of_student_Greenfire_tickets" size="2" type="text" value="" id="number_of_student_Greenfire_tickets" /></span><label for="number_of_student_Greenfire_tickets">x</label> $10</div> </td> <td width="10"> <div align="center">=</div> </td> <td>$<input name="Greenfire_total_cost" size="4" type="text" value="" id="Greenfire_total_cost" /></td> </tr> <tr> <td></td> </tr> <tr> <td> <p><strong>Green Fire &amp; Curt Meine</strong><br /> February 3, 2012<br /></p> </td> <td></td> <td bgcolor="#ffffff"></td> <td bgcolor="#ffffff"> <div align="center"> <div align="center"><span style="text-decoration:line-through"><input name="number_of_alumni_encore_tickets" size="2" type="text" value="" id="number_of_alumni_encore_tickets" /></span><label for="number_of_alumni_encore_tickets">x</label> $10</div> </div> </td> <td bgcolor="#ffffff"> <div align="center"><span style="text-decoration:line-through"><input name="number_of_general_encore_tickets" size="2" type="text" value="" id="number_of_general_encore_tickets" /></span><label for="number_of_general_encore_tickets">x</label> $15</div> </td> <td bgcolor="#ffffff" width="71"> <div align="center"><span style="text-decoration:line-through"><input name="number_of_student_encore_tickets" size="2" type="text" value="" id="number_of_student_encore_tickets" /></span><label for="number_of_student_encore_tickets">x</label> $10</div> </td> <td width="10"> <div align="center">=</div> </td> <td>$<input name="encore_total_cost" size="4" type="text" value="" id="encore_total_cost" /></td> </tr> <tr> <td bgcolor="#cccccc"><strong>Ken Waldman<br /></strong> February 22, 2012</td> <td bgcolor="#cccccc"></td> <td bgcolor="#cccccc"></td> <td bgcolor="#cccccc"> <div align="center"> <div align="center"><input name="number_of_alumni_Waldman_tickets" size="2" type="text" value="" id="number_of_alumni_Waldman_tickets" /><label for="number_of_alumni_Waldman_tickets">x</label> $15</div> </div> </td> <td bgcolor="#cccccc"> <div align="center"><input name="number_of_general_Waldman_tickets" size="2" type="text" value="" id="number_of_general_Waldman_tickets" /><label for="number_of_general_Waldman_tickets">x</label> $20</div> </td> <td bgcolor="#cccccc" width="71"> <div align="center"><input name="number_of_student_Waldman_tickets" size="2" type="text" value="" id="number_of_student_Waldman_tickets" /><label for="number_of_student_Waldman_tickets">x</label> $13</div> </td> <td bgcolor="#cccccc" width="10"> <div align="center">=</div> </td> <td bgcolor="#cccccc">$<input name="Waldman_total_cost" size="4" type="text" value="" id="Waldman_total_cost" /></td> </tr> <tr> <td><strong>Nrityagram</strong><br /> March 16, 2012</td> <td></td> <td bgcolor="#ffffff"></td> <td bgcolor="#ffffff"> <div align="center"><input name="number_of_alumni_Nrityagram_tickets" size="2" type="text" value="" id="number_of_alumni_Nrityagram_tickets" /><label for="number_of_alumni_Nrityagram_tickets">x</label> $20</div> </td> <td bgcolor="#ffffff"> <div align="center"><input name="number_of_general_Nrityagram_tickets" size="2" type="text" value="" id="number_of_general_Nrityagram_tickets" /><label for="number_of_general_Nrityagram_tickets">x</label> $25</div> </td> <td bgcolor="#ffffff" width="71"> <div align="center"><input name="number_of_student_Nrityagram_tickets" size="2" type="text" value="" id="number_of_student_Nrityagram_tickets" /><label for="number_of_student_Nrityagram_tickets">x</label> $13</div> </td> <td width="10"> <div align="center">=</div> </td> <td>$<input name="Nrityagram_total_cost" size="4" type="text" value="" id="Nrityagram_total_cost" /></td> </tr> <tr> <td bgcolor="#cccccc"><strong>SIU Orchestras &amp; David Kim</strong><br /> March 28, 2012<br /></td> <td bgcolor="#cccccc"></td> <td bgcolor="#cccccc"></td> <td bgcolor="#cccccc"> <div align="center"> <div align="center"><input name="number_of_alumni_SIU_tickets" size="2" type="text" value="" id="number_of_alumni_SIU_tickets" /><label for="number_of_alumni_SIU_tickets">x</label> $15</div> </div> </td> <td bgcolor="#cccccc"> <div align="center"><input name="number_of_general_SIU_tickets" size="2" type="text" value="" id="number_of_general_SIU_tickets" /><label for="number_of_general_SIU_tickets">x</label> $15</div> </td> <td bgcolor="#cccccc" width="71"> <div align="center"><input name="number_of_student_SIU_tickets" size="2" type="text" value="" id="number_of_student_SIU_tickets" /><label for="number_of_student_SIU_tickets">x</label> $13</div> </td> <td bgcolor="#cccccc" width="10"> <div align="center">=</div> </td> <td bgcolor="#cccccc">$<input name="SIU_total_cost" size="4" type="text" value="" id="SIU_total_cost" /></td> </tr> <tr> <td bgcolor="#ffffff"><strong>Squonk<br /></strong> June 6, 2012</td> <td bgcolor="#ffffff"></td> <td bgcolor="#ffffff"></td> <td bgcolor="#ffffff"> <div align="center"><input name="number_of_alumni_Squonk_tickets" size="2" type="text" value="" id="number_of_alumni_Squonk_tickets" /><label for="number_of_alumni_Squonk_tickets">x</label> $20</div> </td> <td bgcolor="#ffffff"> <div align="center"><input name="number_of_general_Squonk_tickets" size="2" type="text" value="" id="number_of_general_Squonk_tickets" /><label for="number_of_general_Squonk_tickets">x</label> $25</div> </td> <td bgcolor="#ffffff" width="71"> <div align="center"><input name="number_of_student_Squonk_tickets" size="2" type="text" value="" id="number_of_student_Squonk_tickets" /><label for="number_of_student_Squonk_tickets">x</label> $13</div> </td> <td bgcolor="#ffffff" width="10"> <div align="center">=</div> </td> <td>$<input name="Squonk_total_cost" size="4" type="text" value="" id="Squonk_total_cost" /></td> </tr> <tr> <td> <p align="right"><strong>Subscription x8 events</strong></p> </td> <td> <div align="center"><input name="number_of_x8_events_tickets" size="2" type="text" value="" id="number_of_x8_events_tickets" />x $123<br /></div> </td> <td></td> <td></td> <td></td> <td width="71"></td> <td width="10"> <div align="center">=</div> </td> <td>$<input name="x8_events_tickets_total_cost" size="4" type="text" value="" id="x8_events_tickets_total_cost" /></td> </tr> <tr> <td valign="middle" colspan="7"></td> <td></td> </tr> <tr> <td valign="middle" colspan="7"> <div align="right"> <p>Subtotal</p> </div> </td> <td>$<input name="subtotal" size="4" type="text" value="" id="subtotal" /></td> </tr> <tr> <td valign="middle" colspan="7"> <div align="right"> <p>Service fee of $2.00 for credit card orders</p> </div> </td> <td>$<input name="service_fee" size="4" type="text" value="2" id="service_fee" /></td> </tr> <tr> <td valign="middle" colspan="7"> <div align="right"> <p>My Contribution to Arts &amp; Issues</p> </div> </td> <td>$<input name="contribution" size="4" type="text" value="0" id="contribution" /></td> </tr> <tr> <td bgcolor="#cccccc" valign="middle" colspan="7"> <div align="right"> <p>Total Ticket Order</p> </div> </td> <td bgcolor="#cccccc">$<input name="total" size="4" type="text" id="total" /></td> </tr> <tr> <td colspan="4"></td> <td></td> <td colspan="3"> <div align="center"><input onclick="calculate()" type="button" value="Calculate" /></div> </td> </tr> </table><br /> <table border="0" width="500" cellspacing="0" cellpadding="5"> <tr> <td width="107">Name:</td> <td><input name="realname" size="30" type="text" value="Full Name" onfocus="this.value=''" id="realname" /></td> </tr> <tr> <td>Address:</td> <td><input name="address" size="30" type="text" value="Address" onfocus="this.value=''" id="address" /></td> </tr> <tr> <td>City:</td> <td><input name="city" size="30" type="text" value="City" onfocus="this.value=''" id="city" /></td> </tr> <tr> <td>State:</td> <td><input name="state" size="8" type="text" value="State" onfocus="this.value=''" id="state" /></td> </tr> <tr> <td>Zip:</td> <td><input name="zip" size="8" type="text" value="Zip Code" onfocus="this.value=''" id="zip" /></td> </tr> <tr> <td>Daytime Phone:</td> <td><input name="phone" size="20" type="text" value="Phone Number" onfocus="this.value=''" id="phone" /></td> </tr> <tr> <td>e-mail:</td> <td><input name="email" size="20" type="text" value="E-mail Address" onfocus="this.value=''" id="email" /></td> </tr> <tr> <td></td> <td></td> </tr> <tr> <td></td> <td><strong>Where did you learn of the event(s) at SIUE?</strong></td> </tr> <tr> <td></td> <td><input name="how_did_you_hear_about_us" type="radio" value="radio" id="radio" />Radio</td> </tr> <tr> <td></td> <td><input name="how_did_you_hear_about_us" type="radio" value="newspaper" id="newspaper" />Newspaper</td> </tr> <tr> <td></td> <td><input name="how_did_you_hear_about_us" type="radio" value="mailing" id="mailing" />Mailing</td> </tr> <tr> <td></td> <td><input name="how_did_you_hear_about_us" type="radio" value="other" />Other: <input name="other" size="25" type="text" value="" onfocus="this.value=''" /></td> </tr> <tr> <td></td> <td></td> </tr> <tr> <td></td> <td><strong>Select how you would like to pay for your tickets:</strong></td> </tr> <tr> <td></td> <td><input name="payment_type" type="radio" value="check" id="check" />Check</td> </tr> <tr> <td></td> <td><input name="payment_type" type="radio" value="mastercard" id="mastercard" />Mastercard</td> </tr> <tr> <td></td> <td><input name="payment_type" type="radio" value="visa" id="visa" />Visa</td> </tr> <tr> <td></td> <td><input name="payment_type" type="radio" value="discover" id="discover" />Discover</td> </tr> <tr> <td></td> <td><input name="payment_type" type="radio" value="american_express" id="american_express" />American Express</td> </tr> <tr> <td></td> <td></td> </tr> <tr> <td valign="top"></td> <td valign="top">We will contact you to take your credit card information.<br /> If you are paying by check:<br /> Make it payable to the SIUE Foundation and mail to:<br /> Arts &amp; Issues<br /> SIUE Box 1777<br /> Edwardsville, IL 62026-1608</td> </tr> <tr> <td></td> <td><input type="submit" value="Submit" /></td> </tr> </table></form>