Lackawanna Historical Society
Registration Form for the
6th annual Grand Civil War Ball, Sat. April 10, 2010 and/or
The Victorian Lady Undressed, Sun. April 11, 2010


Name: ______________________________________________________________________
Address: ______________________________________________________________________
City, State, Zip: ______________________________________________________________________
Phone: ______________________________________________________________________
email: ______________________________________________________________________

Description

Quantity and Price

Amount

Grand Civil War Ball / Dancing
(single person registration)

_____ number of single people at $35 per person

_______

Grand Civil War Ball / Dancing
(registering as a couple)

_____ number of couples at $60 per couple

_______

Grand Civil War Ball / Spectator Tickets
(non-dancing)

_____ number of LHS tickets $5 per member
_____ number of non-member tickets at $7 per person

_______

The Victorian Lady Undressed
(Victorian Tea, Fashion Show & Lecture)

_____ number of people at $30 per person ($35 after Apr 2)

_______

Total ---->>

_______

Send this form along with a check made payable to:

Lackawanna Historical Society - Civil War Ball
232 Monroe Ave., Scranton, PA 18510

Thank You for your support!