Dance Card Checkout


	Step 1: Select Dance Card Package and Number of Tickets * Indicates required field
	Select Your Package Below*
	Select Number of Tickets* Minimum of 4
	Sub Total $
	Tax-Deductible Contribution $
	Grand Total $


	Step 2: Mailing Address * Indicates required field
	Name*
	Mailing Address* City State Zip Code
	Daytime Phone*
	Evening Phone*
	Cell Phone
	Email*


	Step 3: Credit Card Information * Indicates required field
	Name on Card*
	Billing Address* City State Zip Code
	Card Type*
	Card Number*
	Expiration* Month Year


	Step 4: How Did You Hear About This Offer? Please Select From The Options Below:
	Social Media (Facebook, Twitter, YouTube) Online Advertisement Email PBT Website Print Advertisement Word of Mouth Other: