Lackawanna Historical Society
Registration Form for the
5th annual Grand Civil War Ball, Sat Apr 18, 2009
and/or
Dance & Dress in High Society on Sun Apr 19, 2009
| 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 |
_______ |
Dance & Dress in High Society |
_____ number of people at $30 per person ($35 after Apr 5) |
_______ |
Total ---->> |
_______ |
Send this form along with a check made payable to: |
Lackawanna Historical Society - Civil War Ball |
Thank You for your support!