2012 Series Ticket Renewal Form1 4 10 12

November 9-10, 2012 Allen Event Center

Benefiting Children’s Charities in North Texas 2012 Series Ticket Renewal Contract My contact information has changed. Please update accordingly

Name:

Company/Organization:

Mailing Address:

Daytime Phone: Fax:

Email:

Referred By:

Preferred Listing in printed materials

2012 Series Ticket Renewal Options _____ OPTION #1: Renew same number of seats and same location as 2011 (Section/Row/Seat:) _____ OPTION #2: Modify your Series Tickets (Number of seats and/or location)

Ticket Level ¨ VIP Rows A-E ¨ Plaza Rows F-S

Same Seat for All 3 Performances (includes arena fees)

No. of Seats (Min. of 2 seats)

Requested Seat Location: Based on

Cost

1.) __________________ $265

X

______

$_______

$140

X

______

$_______

Total Series Ticket Amount:

$_______

2.) __________________

+ $500.00

+

Min $500 Membership/Donation

Payment Information: Cash

Check (Enclosed)

Credit Card

MasterCard

Visa

$5.00

=

$

Processing Fee

American Express

Name on Card: _________________________________ Card #:_________________________________ Exp. _____/____ Signature of card holder: __________________________________ Date: ______________ Amount: _____________ For Office Use Only PP: ________________ RE: ________________

Mail the completed membership application to 2914 Swiss Ave. Dallas, TX 75204, Or fax the completed form to (214) 522-3350 Attn: Series Tickets www.texasstampede.org