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TICKET ORDER FORM

Reflections, A Tribute to Jerry Garcia
A Benefit for the Rex Foundation

Saturday, December 5, 2015
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
Mission In The Rain $1,041.00 • Reserved Center Front Floor Seating
Ill Take A Melody $521.00 • Reserved Front Floor Seating
They Love Each Other $266.00 • Reserved Floor Seats
Floor Seating Concert Only Tickets and Event Poster (All but $75 is tax deductible)

 

Name________________________________________________(As It Appears On Credit Card)

Address___________________________________________________________________

City_______________________________ State________ Zip_______________________

Telephone_____________________ E-Mail______________________________________

Type of Ticket:  Mission In The Rain,  I'll Take A Melody,  They Love Each Other,
 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 5th.

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

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