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ORDER FORM   –   LCCA CONCERT SERIES 2009 - 2010

CUT OFF AND RETURN WITH YOUR TICKET ORDER/DONATION

 

Please consider an additional contribution and                Adult……………………………………..$40.00

Have your name included in our program as a:                Children (under 18)..No Charge (if accompanied by adult)

 

Patron (includes 2 tickets)……………….$ 110              Adult Season Tickets _____x $40.00= $_______

Sustainer (Silver)(includes 4 Tickets)…   $ 250

Sponsor (Gold) (includes 6 tickets)……   $ 500              Additional Contribution ……………   $______

Underwriter (includes 10 tickets)… Over $ 500

                                                                                          Total…………………………………..$ ______

 

Name(s)________________________________________________________       For more information,

                                                                                                                                     please contact
Address:________________________________________________________       Charles Edwards
                                                                                                                                     812-279-6542
Phone:_____________________________Email:_______________________ 
 
Mail to:  Lawrence County Concert Assoc., P.O. Box 56, Bedford, IN 47421