~ LET’S DANCE ~ ART IN MOTION ~
_____ Please reserve _____ ticket(s) at $45 each.
_____ Reserve one Table for 10 at $450.00* 		Total $_________
*the full payment of $450 must be enclosed to reserve a table
please list names below
_____ I / We are unable to attend, but please accept this donation of     $_________
NAME: _____________________________________________________
ADDRESS: __________________________________________________
__________________________________________________
PHONE: _________________________ EMAIL:_________________________
PAYMENT METHOD:☐ Check payable to TCAG
☐ Credit Card (Visa or MasterCard)

Account #:____________________________________________
Exp Date: _____/_____

Name on Account: ____________________________________________

Signature: __________________________________________________
 


There are a limited number of reserved tables for 10 available and will be assigned on a first-come basis. The full amount of $450 must be enclosed with this form to reserve your table, even if you do not list all the names.

Please list the other members of your party:

 1. _______________________________________________
 2. _______________________________________________
 3. _______________________________________________
 4. _______________________________________________
 5. _______________________________________________
 6. _______________________________________________
 7. _______________________________________________
 8. _______________________________________________
 9. _______________________________________________
10. _______________________________________________