Dipson Theatres

Please fill out the following form and a Dipson Theatres representative will contact you.

*First Name:
*Last Name:
*Street Address:
Address 2:
*City:
*State:
*Zip:
*Daytime Phone:
*Evening Phone:
*Email:
Theatre:
Are you 18 yrs of age or older?:	Yes
Relation:	Are you related or associated with in any way to a Dipson Theatres employee?
Secret Shopper Agent Agreement:	I do solemnly swear that I have read and fully understand the rules and regulations of becoming a Secret Agent for the Agency. I am not a member of any other secret agency. I am not related, associated, having common descent or origin, in correspondence with anyone at the Agency = Dipson Theatre Company. I agree to be a voluntary member of the Secret Agent Society and I will participate fully with the best covert objective observations, and I understand that failure to submit my mission statements will equate to being disavowed without compensation or refund of any kind. I further understand that I am not an employee of Dipson Theatres and have no rights under any Employment Act.
*	I have read the agreement and agree to the rules

	* denotes required field