| Name: |
|
|
| Charity Event |
| Our Children
need your help |
| Ticket Order Form |
| State: |
| Address: |
| Phone Number: |
| Zip Code: |
| I want Tickets |
| Tickets X $50.00 |
| Total Amount Enclosed |
| Please check one: |
| Fill in text blocks and print |
|
Please send 8 tickets and reserve Table # I
have enclosed $400 |
| Remit To: |
| Please send a self addressed stamped envelope |
| Make checks payable to: Jamil Beachcombers |
| C/O The BeachCombers |
| Columbia, South Carolina 29221-0578 |
Office: 803-772-9380
Fax: 803-772-9382
| Tickets sold at the door, will be $60.00 per person |
| 206 Jamil Rd |
| Please send me |
| I am unable to attend. I have enclosed a donation in the amount of |
| The Jamil Shrine Center |
| Children up to age 18 with orthopaedic conditions, burns, spinal cord injuries, and cleft lip and palate are eligible for care at Shriners Hospitals for Children® and receive all services at no financial obligation to families. |
