Banquet Ticket Order Form

  
NCAA Division II Outdoor Track & Field Championships
 

 
Mail form and
payment to:
NCAA Championship Coordinator
Cal Poly Pomona Athletics
3801 West Temple Avenue
Pomona, CA 91768

Required Information ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••

Name Home Phone: Work Phone:

Home Address City

State Zip Number of tickets: X $35.00 per ticket = $

 

Payment Information •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••
Make checks payable to:
Cal Poly Pomona Foundation
All checks must be received
by Friday, May 21, 2004		 Order form must be accompanied by full payment.
You may pay by check, money order, cashiers check,
or credit card (no cash please).

If paying by credit card you can print and fax this form to Chris Ward at (909) 869-2814
If paying by credit card please fill out the information below:

Name on Card Expiration Date Card Type:

Card Number Security Code (click on the "?" for help)

Amount to be Charged $

 

______________________________________________________________ Date:
Signature