_____ @ $65/Member = $ _______
_____ @ $75/Non-Member = $ _______
_____ Wine or Beer @ $15/glass = $ _______
Total = $ _______
Fill in the number of attendees and the number of wine and beer tickets; calculate your total payment and mail this
form along with your check or credit card information to:
Friends of the Orlando Philharmonic Orchestra
114 Hollie Ct
Maitland, FL 32751
_____ Check enclosed
_____ Please charge my credit card:
VISA | MC | Discover | AmEx
Name on Card: _________________________________________________
Address: ______________________________________________________
City: ______________________________ State: _____ ZIP: _______
Card No.: _____________________________________________________
CCV: ____________________ Expiration Date: ______ / ______
Signature: ____________________________________________________
Payment is required by Friday, May 5.