Dear Friend,

The 2023 Irem Shrine Circus will be held April 10th to April 16th, 2023. It is our hope that your group, limited to one (1) chaperone for each five (5) attendees, will attend as our guest. If more chaperones are desired there will be a charge of $5.00 per chaperone. This FEE IS TO ACCOMPANY THE APPLICATION.

Please complete this form online, then print it. Fax the printed form to 570-714-0305, mail it to the Irem Shrine Circus Office, 22 East Union Street, Kingston, PA 18704, or email it to iremcircus@gmail.com.

Deadline for receipt is March 9th, 2023.

Handicapped will receive special consideration, however, we must limit wheelchairs to four (4) per show per group. Please list total attending and alternate performance dates. Your strict attention to seats requested and circus attendance will be greatly appreciated.

Reservations are accepted on a first-come first-serve basis

Sincerely,
James Roberts Jr.
Guest Chairman
(570) 714-0783

Group Name Group Leader
Address Phone
Preferred Seating:     Main Floor Balcony
Special Instructions or Requests:
Monday 1:30 P.M. (4/10)   # of Children   # of Adults      
  # of Wheelchairs   # of Buses   # of Vans
Monday 7:00 P.M. (4/10)   # of Children   # of Adults      
  # of Wheelchairs   # of Buses   # of Vans
Tuesday 6:30 P.M. (4/11)   # of Children   # of Adults      
  # of Wheelchairs   # of Buses   # of Vans
Wednesday 10:00 A.M.* (4/12)   # of Children   # of Adults      
  # of Wheelchairs   # of Buses   # of Vans
Thursday 10:00 A.M.* (4/13)   # of Children   # of Adults      
  # of Wheelchairs   # of Buses   # of Vans
Friday 10:00 A.M.* (4/14)   # of Children   # of Adults      
  # of Wheelchairs   # of Buses   # of Vans