License Application Form

                            Warsaw, .................................

AGENCJA DRAMATU I TEATRU

02 -375 Warszawa

ul. Piotrkowska 5/8

.............................................

(Theatre/Firm)

 

APLICATION  FOR AN AGREEMENT (staging/reading*)

 

1.

 

A tittle of a play:

 

 

 

2.

Tittle of a play in original language:

 

 

3.

 

Author

:

 

4.

 

Translator:

 

 

5.

Author of Adaptation:

 

 

6.

 

                      Artistic Director:

 

 

7.

Date of an Opening:

 

 

8.

Place of an Opening:

 

 

9.

Name of a stage:

 

 

10.

 

Number of Seats:

 

 

11.

Tickets Prize:

 

 

12.

Period of an Agreement:

 

 

13.

Number of performances planed during a validity of an Agreement:

 

 

14.

A gross box office receipts calculated for one performance:

 

 

15.

Planed a guest performances:

Yes or No?

 

 

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(signification of a theatre/firm)

 

 

*Choose the right one