AMERICA 250 CELEBRATION & DINNER RESERVATION - online reservation form

First name

Last name

Address

Email

Phone

# of Single Tickets $28 (1=1 ticket)

# of Couple Tickets $47 (1=2 tickets)

Sponsorship Table Choice (optional)

America 250 Table $1,000

Presidential Table $800

Charlie Kirk Table $600

Total Amount Due: (donations are not tax deductible as a charitable organization)

$

If amount due is over $250 please provide occupation (required by Political Campaign Finance Law)

Please sign to verify that Corporate money has not been used for this donation. (Political Campaign Finance Laws do not allow corporate donations.)

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COMMENTS/NOTES:

CHOOSE ONE OPTION TO SUBMIT AND PAY BELOW.

NOTE: IF YOU WILL BE PAYING AT THE DOOR,

WE CAN ONLY ACCEPT CASH

Pay online with your card or

save us the processing fees and

choose to pay "cash payment" to pay by cash or check.

Checks payable to TCRC, 128 East Ave., Wellsboro PA 16901

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