Order Form
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| Name:
Address: |
____________________________________
____________________________________ ____________________________________ ____________________________________ |
| Telephone: | ____________________________________ |
(Children under 5 years of age are free - 5 and older pay full price.)
| _____ Tickets @ $35.00 (Price Includes VA Sales Tax) |
$ |
| Certified Mailing Fee | $ 5.00 __________ |
| Total | $ |
| _____ Check enclosed (to Chincoteague Chamber of Commerce) |
| _____ Visa _____ MasterCard |
| Credit card number: ___________________________ |
| Expiration date (month/year):______________ |
| Name (please print) as appears on card:_________________________ |
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Signature:______________________________ |