To order your tickets for the upcoming "Tie One On" Lakewood (October 15, 2008) wine tasting benefit, please fill out the form below. You will be sent to PayPal for processing, enter the total amount and follow their screens. You do not need to be a member to enjoy this great event, but if you wish to join please fill out that section and add that amount to the total.
Name:
Address:
City/State:
Zip
Phone:
Email:
Number of Tickets
Total Amount: Number X $30.00 Each
If you have a MyLakewoodCard you can deduct $2.00 from each ticket. Enter your card number here to get your reduced ticket rate.
MyLakewoodCard Number: ...*Required Number
MyLakewoodCard Discount. (-)
If you wish to join as a great Lakewood sponsor of the Culture & the Arts, Please check your box below and add the amount to the total. If not, please leave blank.
(Check Box) Chianti, 2 Tickets/2 wine glasses, List in program, name on web site $250.00
(Check Box) Chardonnay , 4 Tickets/4 wine glasses, List in program, name on web site $500.00
(Check Box) Cabernet, 6 Tickets/6 wine glasses, List in program, bring banner and name on web site
 $750.00
(Check Box)Champagne, 8 Tickets/8 wine glasses, List in program, bring banner and name on web site $1000.00
(Check Box) Just donate to a great cause. Thank You: Donation-- Enter amount in PayPal
Grand Total: