The 2009 BRC JUNE GALA Ticket Order Form by MikeCallan

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									                          The 2009 BRC JUNE GALA




                        The 2009 BRC JUNE GALA

                            Ticket Order Form

Name:

Title:

Company:

Address:

City:

Province:

Postal Code:

Telephone:

Fax:

Email:


Number of Individual                             @ $147 each
tickets:                                         ($140.00 + GST)
Number of                                        @ $1470 each
Tables:    (10 ppl                               ($1400.00 + GST)
per table)
                       Please Note: Tickets will not be issued until payment
                       has been received.
                                                 We Accept Visa, AMEX,
Credit Card Type:
                                                 MasterCard
Credit Card Number:

Expiry Date:

Name on Card:

 Print      Reset      Please fill out the form, print, and send a copy to:

                                   Taylor Kormann
                                   c/o Television Bureau of Canada
PDF                                160 Bloor Street East, Suite 1005
                                   Toronto, ON M4W 1B9
                                   Tel: 416-413-3864
                                   Fax: 416-413-3879
                                   Email: tkormann@tvb.ca


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                   The 2009 BRC JUNE GALA



                Tickets are refundable up until Tuesday June 16, 2009 at
Refund Policy   5pm. After that date we will not allow for tickets to be
                refunded.




                             Page 2

								
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