Pay template

Document Sample
Pay template Powered By Docstoc
					     Smith Center of the Performing Arts
                                RSVP Payment Form
                        Wednesday July 8th beginning at 5:30
            241 W. Charleston Blvd. Ste 111—at the Holsum Lofts



City_________________________________ Zip______________

Phone________________________ Fax_________________________


Number of members attending_______ ($10.00 each)            Total____________

Number of non-members attending_______($15.00 each)         Total____________

___Visa __MC      Credit Card Number_______________________________________

Expiration Date _________________ 3 digit security code on back__________

Authorized Signature______________________________________________________

                          Three methods of payment
1. Fax form to: (702)435-9224           2. Email information to:

3. Mail this form with a check payable to: ADAS
Send to:
Carla Dirk, Treasurer                          For Questions regarding payment,
1254 Dove Tree Court                           please call:
Henderson, NV 89014                             702-639-1800