Name:

ABS#:

City & State:

Adult Guest Names:

Child Guest  Names:

Ticket Order

Cost

Qty

Total

Adult Dinner

$25

Child Dinner (age 10 and under)

$13

TOTAL

PAYMENT:    1Check         1MasterCard          1Visa
 

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Name on Card ____________________________________________________________________

Fax to 316-9450-1710 or mail to address below