2012B TS Charity Gala Table and Ticket Order Form FINAL

 

2012 Texas Stampede Charity Gala - Table and Ticket Order Form Thursday, November 8, 2012 - 7:00 p.m. to 10:00 p.m. Courtyard by Marriott, Allen, TX $500 - VIP TABLE One table of 10 - Premium Table Location  ,1',9,'8$/7,&.(7 One ticket to the Texas Stampede Charity Gala

I WOULD LIKE TO SUPPORT THE 2012 TEXAS STAMPEDE CHARITY GALA: $500 VIP Table (enter desired quantity of VIP Tables) _______ = $_______________ $25 Individual Ticket (enter desired quantity of Individual Tickets) _______ = $_______________ All contributions are tax-deductable to the extent allowed by law. TOTAL PURCHASE $______________ Individual or Company Name: ______________________________________________________________________________________ __ (Please print Individual or Company Name as you would like it to appear in print) Address: ___________________________________________________ City: ________________________ ST: ______ Zip: ______________ Office Phone: Home Phone: Name of Contact Person: E-mail Address: Seller: _________________________________________ I do not wish to be listed in print materials. I am unable to attend, but wish to make a $ ______________ contribution to Texas Stampede, Inc. BILLING AND PAYMENT INFORMATION: My check made payable to the Texas Stampede is enclosed. Check # ______________ Please bill my credit card (Check One): _______Amex _______MasterCard_______Visa_______ Credit Card Number: Exp. Date: Cardholder Name: Cardholder Signature:

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TEXAS STAMPEDE CHARITY GALA TICKETS WILL BE MAILED 2- 3 WEEKS PRIOR TO THE EVENT.    PLEASE MAIL OR FAX FORM TO:   Texas Stampede, Inc. ‐ 2914 Swiss Ave., Dallas, Texas 75204  214.520.8874 OFFICE 214.520.8874 FAX