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Registration Form

Please complete the form below. When you have submitted your form, you will be automatically directed to the deposit payment page. If you are not automatically directed there, you can either click here or on the button at the bottom of this page to proceed. Deposit payment is required to complete registration.

All required questions are marked with *

Legal Name (as listed on your identifcation) *

First

Last

Preferred Name *

Date of Birth (MM/DD/YYYY) *

Street Address *

City, State, Zip *

Phone Number *

Email Address *

Emergency Contact Name *

First

Last

Relationship to You *

Emergency Contact's Phone Number *

Emergency Contact's Email Address *

Air Travel *

I will travel roundtrip with the group on these dates: PORTLAND to NEW YORK on May 19 , 2025; NEW YORK to PORTLAND on May 23, 2025.
I will make my own travel arrangements to and from NEW YORK. (If you plan to fly only one-way with the group, you will need to arrange your own travel both ways.)

Hotel: Millenium Broadway Hotel New York (145 West 44th Street) *

Double Occupancy: One King
Double Occupancy: Two Queens
Double Occupancy: No preference
Single Occupancy (Add $900 to base trip cost.)

If traveling alone, would you like us to assign you a roommate? (If we cannot find a roommate for you, you will be charged for a single room.)

Dining: Do you have special dietary restrictions? *

If you DO have dietary restrictions, please describe in one sentence:

THE ACTIVITIES ON THE TOUR REQUIRE HEAVY WALKING AND FREQUENT STAIRS - THOSE PLANNING ON ATTENDING SHOULD EITHER BE ABLE TO NAVIGATE LONG DISTANCES WITHOUT SUPPORT, OR BRING ANOTHER INDIVIDUAL WHO CAN SUPPORT THEM. *PLEASE TYPE YOUR FULL NAME HERE TO INDICATE YOU CAN COMPLY WITH THESE TERMS.* *

If you are not automatically redirected to the deposit payment page after submitting your registration form, please click the button below. Deposit payment is required to complete registration.

Proceed to deposit payment

Broadway Rose Theatre Company
12850 SW Grant Ave.
Tigard, OR 97223

Mail:
P.O. Box 231004
Tigard, OR 97281

Box Office: 503.620.5262
Admin: 503.603.9862

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