Awards Night & Dinner Dance Ticket Order
1. Complete this form on your computer screen,
2. Print this page,
3. Make your check out to to Burlington County Footlighters, Inc.
3. Mail this page with your check BEFORE MAY 27, 2005 to:

Footlighters Awards Nite
Attn: Dennis Dougherty
808 Pomona Road
Cinnaminson, NJ 08077

If possible, I would like to sit with: Write on back for more room.
Name
Street
City
State   Zip
Daytime A/C-Phone -
Evening A/C-Phone -
Your e-mail address:
Choice of Entree Romano Crusted Chicken   
Filet of Salmon with Citrus Butter
Amount Enclosed
Check or money order enclosed. Do not send cash.