Purchase Tickets

I WOULD LIKE TO PURCHASE:

_________ # Table(s) at $175 each table (six seats per table) = $__________

Name/Business Name: ________________________________________________________

Contact Person: ______________________________________________________________

Address: ___________________________________________________________________

City: ___________________________________ State: ______________ Zip: _____________

Telephone Number: _______________________E-mail: _______________________________

Payment (MasterCard or Visa)

Card # __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Expiration Date: _________________

Name on the Card: ___________________________________________________________

Signature: _______________________________________ Billing Zip Code: ______________

Make checks payable to: City of Ellisville

Mail to: City of Ellisville

1 Weis Avenue

Ellisville, MO 63011

Please reserve and pay by October 13, 2023

For additional information contact:
 Ada Hood at ahood@ellisville.mo.us