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Good News Home for Women
Ticket Order Form

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TOTAL NUMBER OF TICKETS    @ $30 Each =   

    

        =   

  =   

       Boosters  List my name(s) in Journal as follows*

    

   EXAMPLE:  John and Jane Doe; Dr. & Mrs. Mark Evans; The Smith Family

 

    =     

        Friends  List my name(s) in Journal as follows*

                              

 

IN MEMORY OF       =   

AND/OR IN MEMORY OF OUR FORMER DIRECTORS:

                             =   

                             =   

*For publication in the Ad Journal, donations must be

  received no later than September 27, 2002.

                                ENTER WHOLE DOLLAR AMOUNTS 0.00    TOTAL  =   

 

MAILING INFORMATION:

                                                                                            

FIRST NAME / LAST NAME              

 

ORGANIZATION / COMPANY        

 

ADDRESS                                           

 

CITY / STATE / ZIP CODE                   

 

TELEPHONE / E-MAIL                        

 

METHOD OF PAYMENT:

                  

                                    CARD NUMBER       EXP DATE:  00 / 0000

 

IF DIFFERENT THAN ABOVE, PLEASE ENTER THE NAME AND ADDRESS EXACTLY AS IT APPEARS ON YOUR CREDIT CARD STATEMENT

                                                        

COMMENTS:

 

 

 

 

 

 

WHEN MAILING OR FAXING, PLEASE INCLUDE CARDHOLDERS SIGNATURE                                                                                                                        

 

NOTICE:   Submitting this form by clicking on the submit bar sends your order in a non-encrypted format, which is only as secure as email transmissions.  

                  In addition to submitting your order online, you have the option of mailing, faxing or calling-in your order.  Submission via Internet is at your own risk.