Lackawanna Historical Society
Registration Form for the
8th annual Grand Civil War Ball, Sat. April 14, 2012
The LHS Titanic Luncheon, Sun. April 15, 2012
| Grand Civil War Ball | $35 if you are registering as an individual (no partner), or $60 if you are registering as a couple. |
| LHS Titanic Luncheon | $35 per person. |
| Name: | ______________________________________________________________________ |
| Address: | ______________________________________________________________________ |
| City, State, Zip: | ______________________________________________________________________ |
| Phone: | ______________________________________________________________________ |
| email: | ______________________________________________________________________ |
Description |
Quantity and Price |
Amount |
Grand Civil War Ball |
_____ number of single people at $35 per person |
_______ |
Grand Civil War Ball |
_____ number of couples at $60 per couple |
_______ |
LHS Titanic Luncheon |
_____ number of people at $35 per person |
_______ |
Send this form along with a check made payable to: |
Lackawanna Historical Society - Civil War Ball |
All proceeds benefit the Lackawanna Historical Society.
Thank You for your support!