Escape To Reality: re(Define)

(Real)ity TM

THE FASHION SHOW

ADVANCED TICKET ORDER FORM

Please mail or fax this form into the office by Monday, February 11, 2008

INFORMATION
Name: __________________________________________________________________
Address: ________________________________________________________________
City: ____________________________ State: __________________ Zip:_____________
Phone Number: ________________________E Mail: _____________________________
TICKET REQUEST  

Premier VIP Seating ($75) Number Requested: ___________________

General Admission ($50) Number Requested: ___________________

PAYMENT INFORMATION

ˆ Visa    ˆ Mastercard    ˆ American Express

Name on Card :___________________________________________________________

Card Number :________________________________     Expiration Date:_____________

Amount :__________________________    Signature: ____________________________

Please make checks payable to The Alliance for Eating Disorders Awareness. All ticket requests received on or before February 11^th

will be send via USPS mail. All requests received after will be held at will call.