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Tickets to 8/1/10 Event, Donations & Membership

OR

COMPLETE THE FORM BELOW AND MAIL, EMAIL OR FAX IN YOUR ORDER.

 

Dear Supporter,                    

You can order by credit card or check.
Please complete, sign and fax, mail or e-mail form below to us. 
The confirmation will be expedited as soon as possible. 
Many thanks for your support!

         Fax:562-988-9197                                             

                         OR

         Mail to: Long Beach Kids Connection, Inc. 

                      6444 E. Spring,  #223, 

                      Long Beach, CA 90815-1553  

                         OR

         Copy and e-mail to: lbkidsconnection@aol.com                                                                                               

  

NUMBER CREDIT CARD:       ________________________ (Visa/MC only)

NAME ON CARD:                    ________________________

ADDRESS:                               ________________________

(cc billing address)                ________________________

EXPIRATION DATE:                ____/____    

SECURITY NUMBER:             _____

NUMBER OF TICKETS:        _______ADULTS-$50 ea

                                                  _______TEENS-$20 ea (13-19)

                                                  _______CHILDREN-$10 each (12 years of age and under)

                                                  _______TABLE for10-$600, includes 1 VIP parking

                                                  _______ DONATION

                                                  _______ OPPORTUNITY DRAWING TICKETS $20 each or 3/$50
                                                                   7 nights for two in NY City at the Manhattan Club
                                                                 

                                                  _______ MEMBERSHIP $50/yr per family or $35/yr per individual
                             

TOTAL AMOUNT:                  $________  

SIGNATURE:                           __________________________

PHONE NUMBER:                  _____________

E-MAIL ADDRESS:                _______________________

 
   

 

This site was last updated 06/15/10

06/15/10