Dancing With Our Stars - Ticket Reservations

Ticket Reservations

Today's Date ____________________________

Name

Billing address

City State ZIP Code

Telephone (home)

Telephone (business)

Fax

E-Mail

Individual Tickets: Number of Seats: _________ @ $120.00 each (10 SEATS = ONE TABLE)

Total Charge: $_______________

Credit card type

(VISA/MC/AMEX) *CVS Number: ____________

Credit card number

Expiration date

Authorized signature :

*CVS number is located on the back of your credit card.

If paying by check please mail and make payable to:

Dancing With Our Stars and mail to:

Bellasport

24305 Town Center Drive, Suite 110

Valencia, CA 91355

If paying by credit card

FAX this form to: Anna Ott @

(661) 259-5480

ENQUIRIES TELEPHONE: (661) 259-3114

Please note:

Dancing With Our Stars will be reflected

on your credit card statement.

PLEASE LIST THE NAMES OF ATTENDEES:

________________________________________

Dancing With Our Stars

TICKET RESERVATION FORM