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Quad-City Plus 60 Club Group Registration - Saturday Performance Sunday, August 22, 2021 – CIRCA’21 Playhouse, 1828 3rd Ave., Rock Island, IL. Dinner, Show, Tax & Gratuity for Meal.

Complete this form, enclose your check payable to “Quad-City Plus 60 Club” for total amount due and mail by Wednesday, August 4th to: Plus 60 , PO Box 455, Bettendorf, IA 52722-0008. Attendees will receive a registration confirmation message via email or phone. Advance registration is required and non-refundable.

Registrant #1 – Print First and Last Name: Plus 60 Membership # Preferred Daytime Phone Number Phone is a:  Home line or ( ) -  Cell Number E-mail Address: Alternate Phone Number Phone is a:  Home line or ( ) -  Cell Number Home Mailing Address, City, State, Zip Code:

Registrant #2 – Print First and Last Name: Plus 60 Membership # Preferred Daytime Phone Number Phone is a:  Home line or ( ) -  Cell Number E-mail Address: Alternate Phone Number Phone is a:  Home line or ( ) -  Cell Number If another party is separately registering by mail and you desire to be seated together at the same table, please list name(s) here:

Determine the Amount of Your Check Payment to Enclose with this Form: CLUB MEMBERS: Pay $53 per person if all individuals listed above are current Club Members. If you have misplaced your membership number, print “Look Up” in the Membership # field and we will research. If you have already applied for or renewed your membership within the past few weeks and haven’t yet received a membership card, print “Pending” in the Membership # field and we will verify. Nothing further needs to be completed below this paragraph. OTHER PERSONS: Leave the Membership # field blank when filling out the event registration form above. In addition to paying $53 per person to register for this event, please mark one box below that applies to you, add the additional amount indicated to your total check payment, and print your birthdate next to your printed name(s) below on the furnished lines:  I am age 55+ and therefore eligible for a 3-year single membership. Enclosed is an additional $10 for Club membership for a total of $63.  We are currently not Club members and either I or my spouse is age 55+. We are eligible for a 3-year joint membership. My total check amount of $121 enclosed equals $106 for two event tickets plus $15 for a 3-year joint Club membership.

______Printed Name of Registrant #1 Birthdate Printed Name of Spouse (if applicable) Birthdate mm/dd/yyyy mm/dd/yyyy

 ------DETACH HERE & SAVE THE INFORMATION BELOW FOR FUTURE REFERENCE ------

Time to put on your

Put some swager into your steps, snap those fingers, and jive with us this summer in air-conditioned comfort at the Sunday, August 22 performance of Saturday Night Fever at CIRCA’21 Dinner Playhouse in Rock Island! Slide back into the ’70s with this sensational salute to ! Tony lives for the weekend when he and his friends can dance the night away. When a big dance competition is announced, he wrangles the beautiful and talented Stephanie to be his partner. Based on the 1977 movie phenomenon that launched the disco era and made a household name, Saturday Night Fever features hit songs from the - such as “Stayin’ Alive,” “,” and “How Deep Is Your Love,” and the high-octane energy and unforgettable swagger will bring you back to the time when disco was king! Doors open at 3:45 PM, Meal from 4 to 5 PM, Bootleggers at 5:15 PM, and Performance at 5:45 PM. Your discounted $53 per Club member Plus 60 ticket to an entertaining evening includes dinner, show, tax and gratuity! You have the option of ordering bar service and/or dessert menu items at your expense during the evening. Reserved seating in our Plus 60 group block will be mostly at tables of four. Complete the above registration form to make your reservation. Saturday Night Fever event registrations must be postmarked no later than Wednesday, August 4th. Send an email to [email protected] with a ‘Saturday Night Fever’ subject line if you have any questions about this event. “On the waves of the air, there is dancin’ out there!” Come and join us!