Lackawanna Historical Society - Registration Form for the
9th annual Grand Civil War Ball (Sat. April 13, 2013)
and Downton Abbey Fashion Show and Tea(Sun Apr 14, 2013)


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

Description

Quantity and Price

Amount

Civil War Ball
(single person registration)

_____ number of single people at $35 per person

______

Civil War Ball
(registering as a couple)

_____ number of couples at $60 per couple

______

Downton Abbey Fashion Show and Tea

_____ number of people at $35 per person

______

Total Amount Enclosed:

______

Send this form along with a check made payable to:

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

All proceeds benefit the Lackawanna Historical Society - Thank You for your support!