First Name
*
Last Name
*
Mobile Phone
*
Email Address
*
Company
Company Title
If not applicable, leave blank.
What best describes you?
*
Professional
Student
Retired
Age Range
*
20-30
30-40
40-50
50+
Your Fox Theatre Memory
*
Share a memorable moment you experienced at The Fox Theatre. Describe who you shared the moment with and why the memory is important to you.
Family's Country of Origin
*
STORY RELEASE CONSENT
I grant the Fox Theatre rights to use my story, likeness, or recording for promotional purposes.
*
Yes, looking to purchase another
No, interested in purchasing and hearing more
I understand my story may be shared publicly by the Fox Theatre in print, digital, or video.
*
Yes, looking to purchase another
No, interested in purchasing and hearing more
I waive approval rights and grant use of my story or image without expectation of payment.
*
Yes, looking to purchase another
No, interested in purchasing and hearing more
