REX logo
TICKET ORDER FORM

A Buck Dancer’s Choice
A Benefit for the Rex Foundation in Honor of Jon McIntire

Saturday, December 1, 2012
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
Uncle “Jon’s” Band $1,010.00 • Reserved Center Front Floor Seating
•Acknowledged as Supporter of Grants Made in Jon’s Honor
Risin’ Tide $ 510.00 • Reserved Front Floor Seating
Morning Sun $ 260.00 • Reserved Floor Seats
Floor Seating Concert Only Tickets and Event Poster (All but $75 is tax deductible)
River Side $ 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:  Uncle “Jon’s” Band  Risin’ Tide  Morning Sun  River Side
 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 3rd.

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

back to:

GDTS TOO Logo and Link