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TICKET ORDER FORM

STANDING ON THE MOON
A Benefit for the Rex Foundation

Saturday, December 6, 2014
The Fillmore, San Francisco, CA 94115

Reception, Food, Premium Seating Concert Tickets and Event Poster: (All but $100 is tax deductible)
Includes Drinks, Hearty Finger Food and Event Poster
Cresent In The Sky $1,040.00 • Reserved Center Front Floor Seating
Lovely View $520.00 • Reserved Front Floor Seating
Mighty Melody $ 265.00 • Reserved Floor Seats
Floor Seating Concert Only Tickets and Event Poster (All but $75 is tax deductible)
Shadow Of The Sun $ 135.00 • Priority Entry When Doors Open at 7:30 • Floor Seating

 

Name________________________________________________(As It Appears On Credit Card)

Address___________________________________________________________________

City_______________________________ State________ Zip_______________________

Telephone_____________________ E-Mail______________________________________

Type of Ticket:  Cresent In The Sky,  Lovely View,  Mighty Melody,  Shadow Of The Sun
 Contribution _______________

No. Of Tickets_______________ Total Amount Paid_____________________________

Visa Mastercard
Card No.__________________________________________________________________

Expiration Date__________________ 3-Digit Security Code______________________

Signature__________________________________________________________________

Notes_____________________________________________________________________

Fax Form to 415-868-9819
or mail to GDTS TOO
P.O. Box 456 Stinson Beach, CA 94970
Thank you for your support. We look forward to seeing you on December 6th.

* All names and address for this performance will be shared with the Rex Foundation.*

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