Christmas Schooner Ticket Order Form

Note: The member price is available to those who are annual dues paying members of EDHS. The member price applies to the member and his/her spouse and children.	$30 TICKETS (EDHS MEMBER) # of tickets $ enclosed	$40 TICKETS (NON-MEMBER) # of tickets $ enclosed

Yes, I would like to make an additional contribution to the Annual Fund in support of the EastlandDisaster Historical Society.	ANNUAL FUND CONTRIBUTION $ enclosed

Salutation
First name
Last name
Spouse name
Street address

City
State/Province
Zip/postal code
Home phone number
Work phone number
E-Mail address

PAYMENT INFORMATION
Personal check		Cashiers check		Money order
VISA			MasterCard

CREDIT CARD INFORMATION
(if paying by VISA or MasterCard)
Account number
Expiration date
Card authorization number (last 3 or 4 digits on reverse side of card)
Name (as it appears on credit card)
Address
City
State
Country
Postal code

Type in the information above and print this form. Then phone, fax or mail form and payment to:
Eastland Disaster Historical Society
P.O. Box 2013
Arlington Heights, IL 60006-2013
1-877-865-6295 (phone)
1-877-865-6295 (fax)

We accept personal checks, cashiers checks, money orders, VISA and MasterCard.