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DECC Sweetheart Dance

Your name

Family and individual tickets

Family entrance @ $60/Family

Families of up to 5

Additional guests @ $25 each

Sponsorship (includes event entrance)

SPONSORSHIP: Please select the sponsorship level of your choice (optional)

Sponsorship Levels include entrance for a family of 5.

Please recognize our sponsorship on event materials as

If you'd like to submit a high resolution logo for event materials, please email the logo to [email protected] by Wednesday, January 30.

Additional donation (optional)

I'd like to make an additional donation $

Please enter donation amount

Attendant Information

Second Attendant Name

Child or Adult

Third Attendant Name

Child or Adult

Fourth Attendant Name

Child or Adult

Fifth Attendant Name

Child or Adult

Account Details

Enter your name and e-mail address for your confirmation:

*E-mail

*First Name

*Last Name

Payment Information

Account

Online Fee:

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Comments

Increase the amount by 3% to cover credit card fees. Please select YES to increase your payment.

Total:

DECC Sweetheart Dance

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Credit Card

Checking Account

For added Security please check the box below.

DECC Sweetheart Dance

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Credit Card

Checking Account

For added Security please check the box below.

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