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.,