Benefit Registration

BENEFIT REGISTRATION FORM

HEIDI JOYCE'S
STAND UP AGAINST DOMESTIC VIOLENCE COMEDY BENEFIT

Please print out, complete, and send registration.

CONTACT INFORMATION


Name:	_____________________________________________
Organization:	_____________________________________________
Street Address:	_____________________________________________
City:	_____________________________________________
State:	_______________________________ Zip:__________
Telephone:	_____________________________________________
Fax Number:	_____________________________________________
Email Address:	_____________________________________________

ORDER

Number of tickets: _______ @ $40 ea. (Advance price until 5 pm 9/26)

TOTAL PAYMENT ENCLOSED: ______________________

PAYMENT (choose method)

Check or Money Order to "Family Violence & Sexual Assault Institute"
(Drawn from bank branch within the US) Enclosed check #:________

Please charge the following: MasterCard Visa

Credit card #: ____________________________ Exp. Date:____________
Print name as it appears on card:_________________________________
Card Billing Address: _______________________________ Zip:________

Signature:_____________________________________________________

BENEFIT REGISTRATION MAILING ADDRESS

Send registration by mail with payment to:

The Brown & Bostwick Group
P.O. Box 1329
Solana Beach, CA 92075

Or, fax registration with credit card information to:

FAX: (858) 792-6153

QUESTIONS?

Contact Betsie Brown
(858) 794-7355
betsie@brownbostwick.com

CONFIRMATION

Email or telephone call - Tickets will be at door

CANCELLATION POLICY

A 75 percent refund will be given for written cancellations faxed, emailed or postmarked by Friday, September 20, 2002. Refunds cannot be made after September 20, 2002.

TICKET INFORMATION

Non-advance tickets will be available for $45 payable at the door.

Ticket purchase is tax deductible to the extent allowed by law. Tax ID number is 75-2401334.