_____ @ $55/person = $ _______
_____ Wine @ $13/drink = $ _______
_____ Beer @ $8/each = $ _______
Total = $ _______
Fill in the number of attendees and the number of beer or wine tickets; calculate your total payment and mail this
form along with your check or credit card information to:
Friends of the Orlando Philharmonic Orchestra
5261 Chiswick Cir
Orlando, FL 32812
_____ 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, December 8.