_____ @ $1,500/table = $ _______
Fill in the number of tables; calculate your total payment and mail this
form along with your check or credit card information to:
Friends of the Orlando Philharmonic Orchestra
c/o Diana Sisley
2837 Lake Baldwin Ln, Apt B305
Orlando, FL 32814
_____ 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 Thursday, September 21.