PHYLLIS TUCKWELL HOSPICE

TICKET ORDER FORM - PICNIC TO MUSIC IN THE PARK

To order tickets for "Picnic To Music In The Park" on Saturday, 5 July 2003
please print and complete this form and send to:
Fundraising Dept, Phyllis Tuckwell Hospice, Ref. MIP4524, Waverley Lane, FARNHAM, Surrey GU9 8BL
Or fax it to 01252 729414
You may also call Claire Walker on 01252 729433 with your credit card details if preferred
 

I wish to pay by  (please tick as appropriate)

Cheque

Postal Order

Mastercard

Visa

Switch

(please make cheques payable to Phyllis Tuckwell Hospice)
Card No:
Expiry Date: Switch Issue No or Start Date:

Please send me the following number of tickets for
"Picnic To Music In The Park" on Saturday, 5 July 2003:
No. of Adult Tickets @ £12.50
 
 
No. of OAP Tickets @ £10.00
 
 
No. of Child Tickets @ £5.00
(under 12 years of age)
 
 
TOTAL AMOUNT
 		 £........................
 
FIRST NAME .............................................................................................
SURNAME .............................................................................................
TITLE .............................................................................................
ADDRESS .............................................................................................
  .............................................................................................
POSTCODE .............................................................................................
DAYTIME TELEPHONE NO .............................................................................................
E-MAIL .............................................................................................
SIGNATURE .............................................................................................
 

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