I would like #_____Tickets at $150 each, enclosed find $___________

OR

_____  I would like a Table for Ten, please find enclosed $1,500

arrive for red carpet interviews, formal photos and paparazzi coverage at 6:15pm

Name__________________________________________________

Address________________________________________________

Date:__________

Name on Credit Card______________________________________

Credit Card Number_____________________

Exp. Date ________________________

3 digit code on back of card__________________________

Billing Zip Code___________________________

Unable to attend but here’s a donation of $__________________

Mail Completed Form With Method Of Payment To:

Kris Green
2024 Arkansas Valley Drive, Ste. # 208 
Little Rock, AR 72212

Provide address for mailing ballots and confirmation.

Address: ____________________________________________________

City/State/Zip_________________________________________________