20th Church Anniversary Online Ticket Form

First Name:       Last Name:

 

Address:

 

City:          State:          Zip code:

 

Home Phone:       Cell Phone:  Email:

 

Adult Tickets: ($50.00)                 Quantity of Tickets: 

 

Child(ren) Tickets: ($25.00)           Quantity of Tickets:

 

Table of 8: ($400.00)                    Quantity of Tables:

 

Please charge my account $

 

Payment Options:

 

 VISA       MC       AMEX      DISCOVERY

 

 

Card #:

 

Expiration Date: (09/13)     CVV# (Three numbers on the back signature panel)

 

Name as it appears on card:

 

  Mail my tickets to the address listed above.                Hold my tickets at will call.

 

For additional information email eventsdayspring@comcast.net or call 717.939.9500 ext.214.