Event Ticket Form
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Ticket Options
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( X )
Dinner & Dance
Per Person
$40.00
$
40.00
Quantity
1
2
3
4
5
6
7
8
9
10
Dance Only (Advance)
Per Person
$15.00
$
15.00
Quantity
1
2
3
4
5
6
7
8
9
10
Dance Only (At the Door)
Per Person
$20.00
$
20.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Choose from one of the PayPal options to
make your payment.
Submit
Should be Empty: