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 14, 2022
For additional information contact:
Ada Hood at ahood@ellisville.mo.us